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Herz Sep 2017There is ongoing debate about the optimal management of severe asymptomatic aortic stenosis (AS). Thus far, current guidelines recommend a watchful waiting strategy for... (Review)
Review
There is ongoing debate about the optimal management of severe asymptomatic aortic stenosis (AS). Thus far, current guidelines recommend a watchful waiting strategy for the majority of asymptomatic patients. However, data on the prognosis of asymptomatic AS are inconsistent. Some reports claim an increased risk of complications and even mortality in this subset of patients when treated conservatively. Several factors are considered to contribute to the impaired outcome of asymptomatic patients, such as progressive myocardial damage or sudden cardiac death, during the watchful waiting period. Indeed, a few nonrandomized studies are available in the literature showing improved survival with early aortic valve replacement during the asymptomatic phase compared with watchful waiting. However, these studies have several limitations particularly with regard to methodology, and thus making a clear recommendation on treatment options impossible. Therefore, randomized controlled trials are urgently needed in order to treat these patients on the basis of adequate evidence.
Topics: Aged; Aortic Valve Stenosis; Early Medical Intervention; Evidence-Based Medicine; Female; Follow-Up Studies; Guideline Adherence; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Prognosis; Risk Factors; Survival Rate; Transcatheter Aortic Valve Replacement; Watchful Waiting
PubMed: 28593422
DOI: 10.1007/s00059-017-4584-z -
Cardiovascular Ultrasound Jun 2006Degenerative aortic valve stenosis includes a range of disorder severity from mild leaflet thickening without valve obstruction, "aortic sclerosis", to severe calcified... (Review)
Review
Degenerative aortic valve stenosis includes a range of disorder severity from mild leaflet thickening without valve obstruction, "aortic sclerosis", to severe calcified aortic stenosis. It is a slowly progressive active process of valve modification similar to atherosclerosis for cardiovascular risk factors, lipoprotein deposition, chronic inflammation, and calcification. Systemic signs of inflammation, as wall and serum C-reactive protein, similar to those found in atherosclerosis, are present in patients with degenerative aortic valve stenosis and may be expression of a common disease, useful in monitoring of stenosis progression.
Topics: Aortic Valve Stenosis; Biomarkers; C-Reactive Protein; Disease Progression; Humans
PubMed: 16774687
DOI: 10.1186/1476-7120-4-24 -
Lancet (London, England) Jun 2009
Topics: Aortic Valve Stenosis; Diagnostic Errors; Heart Valve Prosthesis Implantation; Humans; Patient Selection; Referral and Consultation; Stroke Volume; Survival Rate; Ventricular Function, Left
PubMed: 19524773
DOI: 10.1016/S0140-6736(09)61105-3 -
Heart (British Cardiac Society) Sep 2021
Topics: Aortic Valve; Aortic Valve Disease; Aortic Valve Stenosis; Humans
PubMed: 34127542
DOI: 10.1136/heartjnl-2021-319560 -
Journal of Intensive Care Medicine 2007Aortic stenosis is a common condition, particularly in the elderly. The treatment is surgical, and any patient with symptomatic severe aortic stenosis should be... (Review)
Review
Aortic stenosis is a common condition, particularly in the elderly. The treatment is surgical, and any patient with symptomatic severe aortic stenosis should be considered for aortic valve replacement. Aortic stenosis causes an increase in afterload to the left ventricle, which when severe can lead to hemodynamic instability. Although the therapy of aortic stenosis is valve replacement, determining whether a patient has symptoms and accurately assessing the severity of stenosis can be difficult. The management of patients with severe aortic stenosis in the intensive care unit setting can be very challenging, particularly when comorbid medical conditions make aortic valve replacement difficult. This article reviews the diagnosis of aortic stenosis, methods of assessing symptoms and severity, and management of severe symptomatic stenosis, particularly in the intensive care unit setting. Components of the history that suggest symptomatic aortic stenosis are presented. The role of physical examination is discussed, as are the echocardiographic means of determining stenosis severity. Other means of assessing severity are addressed, as are circumstances in which there can be difficulty in interpretation, such as severe aortic stenosis and left ventricular dysfunction. Management of patients, focusing on the intensive care unit setting, is reviewed, with a focus on the timing of aortic valve replacement.
Topics: Aortic Valve; Aortic Valve Stenosis; Echocardiography; Humans; Intensive Care Units; Risk Assessment
PubMed: 17259565
DOI: 10.1177/0885066606295298 -
The Journal of Heart Valve Disease May 2004
Review
Topics: Aortic Valve; Aortic Valve Stenosis; Cardiac Catheterization; Humans; Ultrasonography
PubMed: 15222279
DOI: No ID Found -
Circulation. Cardiovascular Imaging Feb 2016Aortic stenosis is the most frequent valvular heart disease. In aortic stenosis, therapeutic decision essentially depends on symptomatic status, stenosis severity, and... (Review)
Review
Aortic stenosis is the most frequent valvular heart disease. In aortic stenosis, therapeutic decision essentially depends on symptomatic status, stenosis severity, and status of left ventricular systolic function. Surgical aortic valve replacement or transcatheter aortic valve implantation is the sole effective therapy in symptomatic patients with severe aortic stenosis, whereas the management of asymptomatic patients remains controversial and is mainly based on individual risk stratification. Imaging is fundamental for the initial diagnostic work-up, follow-up, and selection of the optimal timing and type of intervention. The present review provides specific recommendations for utilization of multimodality imaging to optimize risk stratification and therapeutic decision-making processes in aortic stenosis.
Topics: Algorithms; Aortic Valve Stenosis; Biomarkers; Humans; Multimodal Imaging; Practice Guidelines as Topic; Prognosis; Risk Assessment
PubMed: 26863917
DOI: 10.1161/CIRCIMAGING.115.004352 -
Vascular Health and Risk Management 2023Cardio-ankle vascular index (CAV) is a measure of systemic arterial stiffness and has been shown to increase after aortic valve surgery. However, change in CAVI-derived...
BACKGROUND
Cardio-ankle vascular index (CAV) is a measure of systemic arterial stiffness and has been shown to increase after aortic valve surgery. However, change in CAVI-derived pulse wave morphology has not previously been addressed.
CASE STUDY
A 72-year-old female was transferred to a large center for heart valve interventions for evaluation of her aortic stenosis. Few co-morbidities were detected on medical history, other than previous radiation treatment for breast cancer, and no signs of other concomitant cardiovascular disease. The patient was accepted for surgical aortic valve replacement due to severe aortic valve stenosis and arterial stiffness was assessed with CAVI, as part of an ongoing clinical study. The pre-operative CAVI was 4.7 which after surgery increased almost 100% to 9.35. In tandem, the slope of systolic upstroke pulse morphology captured from brachial cuffs was changed from a prolonged flattened pattern to a steeper.
CONCLUSION
After aortic valve replacement surgery due to aortic valve stenosis, in addition to increased CAVI-derived measures of arterial stiffness, the slope of the CAVI-derived upstroke pulse wave morphology changes to a steeper slope. This finding could have implications in the future of aortic valve stenosis screening and utilization of CAVI.
Topics: Female; Humans; Aged; Ankle; Pulse Wave Analysis; Cardio Ankle Vascular Index; Ankle Brachial Index; Vascular Stiffness; Aortic Valve Stenosis
PubMed: 37251602
DOI: 10.2147/VHRM.S401221 -
American Heart Journal May 1993
Topics: Aortic Valve Stenosis; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Humans
PubMed: 8480616
DOI: 10.1016/0002-8703(93)91036-e -
Vojnosanitetski Pregled 2003There is a long latent period in the clinical course of aortic valve stenosis in adults. Symptoms usually occur in the case of critical stenosis, when aortic orifice...
There is a long latent period in the clinical course of aortic valve stenosis in adults. Symptoms usually occur in the case of critical stenosis, when aortic orifice area is under 0.7 cm2 (0.4 cm2/m2). In this study 78 patients with critical aortic valve stenosis were investigated. The first manifestation of the disease was dyspnea (78.2%), angina (52.5%), less often a syncope (34.6%), while 17.9% of patients were asymptomatic. Left ventricular systolic function was preserved in 77% of patients, while left ventricular dyastolic dysfunction occurred in almost all the patients. In 42 patients (53.4%) aortic valve replacement was performed. Left ventricular systolic function improved in 88.1% of patients postoperativelly, as well as in patients with preoperatively preserved or poor systolic function. Recovery was fast particularly during the first 6 postoperative months. After the surgery the improvement of the left ventricular dyastolic function was slower then systolic, particularly in patients with extreme hypertrophy of myocardium in whom the process of recovery might last several years.
Topics: Adolescent; Adult; Aged; Aortic Valve; Aortic Valve Stenosis; Female; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Prognosis; Ventricular Function, Left
PubMed: 12852159
DOI: 10.2298/vsp0302167r