Aortic stenosis causes

Aortic Stenosis Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editors-In-Chief: Claudia P. Hochberg, M.D. [2]; Abdul-Rahman Arabi, M.D. [3]; Keri Shafer, M.D. [4]

Etiology

The etiology of Left-Sided Outflow Obstruction can be divided into two broad categories:

1. Acquired Aortic Stenosis and
2. Congenital Left-Sided Outflow Obstruction

Major causes and predisposing conditions of aortic stenosis include acute rheumatic fever and bicuspid aortic valve. As individuals age, calcification of the aortic valve may occur and result in stenosis. This is especially likely to occur in people with a bicuspid aortic valve, but also occurs in the setting of perfectly normal valves as a result of age-induced 'wear and tear'. Typically, aortic stenosis due to calcification of a bicuspid valve occurs in the 4th of 5th decade of life, whereas that due to calcification of a normal valve tends to occur later - around the 7th or 8th decade.

Of the various forms of aortic stenosis, the calcific type is predominant. Since calcific aortic stenosis shares many pathological features and risk factors with atherosclerosis, and since atherosclerosis may be prevented and/or reversed by cholesterol lowering, there has been interest in attempting to modify the course of calcific aortic stenosis by cholesterol lowering with statin drugs. Although a number of small, observational studies demonstrated an association between lowered cholesterol and decreased progression, and even regression, of calcific aortic stenosis, a recent, large randomized clinical trial, published in 2005, failed to find any predictable effect of cholesterol lowering on calcific aortic stenosis. However, a 2007 study did demonstrate a slowing of aortic stenosis with the statin rosuvastatin.

Genetics

Congenital bicuspid valve is the most frequent form of congenital heart disease affecting approximately 1-2% of the population. 1/3rd of Supravalvular Aortic Stenosis cases are transmitted as an autosomal dominant trait as 60% of patients with supravalvular obstruction have Williams syndrome (supravalvular obstruction, intellectual impairment and facial abnormalities).