Aortic stenosis natural history, complications and prognosis: Difference between revisions
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{{Aortic stenosis}} | {{Aortic stenosis}} | ||
{{CMG}}; '''Associate Editors-In-Chief: ''' Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu], [[User:Abdarabi|Abdul-Rahman Arabi, M.D.]] [mailto:abdarabi@yahoo.com], [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu | {{CMG}}; '''Associate Editors-In-Chief: '''[[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@perfuse.org], Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu], [[User:Abdarabi|Abdul-Rahman Arabi, M.D.]] [mailto:abdarabi@yahoo.com], [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu] | ||
==Overview== | ==Overview== | ||
Revision as of 16:18, 11 October 2011
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Aortic Stenosis Microchapters |
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Diagnosis |
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Treatment |
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Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty |
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Transcatheter Aortic Valve Replacement (TAVR) |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Mohammed A. Sbeih, M.D. [2], Claudia P. Hochberg, M.D. [3], Abdul-Rahman Arabi, M.D. [4], Keri Shafer, M.D. [5]
Overview
Aortic valve stenosis can lead to serious complications if left untreated because it can weaken the heart. If the aortic valve is narrowed, the left ventricle strains to pump the required amount of blood into the aorta and to the rest of the body, the left ventricle becomes hypertrophied to compensate the narrowing of the valve. Eventually these changes weaken the left ventricle and the whole heart.
Aortic valve stenosis can lead to life-threatening heart problems if it has not been managed appropriately.
As with any surgical intervention, surgical therapies for aortic stenosis carry risks and potential for complication. These complications commonly include vascular issues such as vascular complications and mitral valve injury.
Natural History
Aortic stenosis has prolonged latent period during which the morbidity and mortality are very low, there may be no obvious symptoms during this period [1]. The average rate of progression in Aortic stenosis -once moderate stenosis is present- is a decrease in valve area of 0.1 cm2 per year [2]. Also in average; there is an increase in jet velocity of 0.3 m per second per year and an increase in mean pressure gradient of 7 mm Hg per year [3] [4][5]. However, there is individual variability in the rate of progression of aortic stenosis.
The rate of progression of AS can be faster in patients with degenerative calcific disease than in those with congenital or rheumatic disease [6]. Progression to AS may occur in patients with aortic sclerosis, defined as valve thickening without obstruction to ventricular outflow. Regular follow-up should be scheduled for all patients with mild to moderate AS, even for asymptomatic patients.
Impaired platelet function and coagulation abnormalities as decreased levels of Von Willebrand factor can be seen in most patients with severe AS. This resolves after valve replacement procedure. 20% of patients have clinical bleeding, most often epistaxis or ecchymoses [7].
If left untreated for a long time, Aortic stenosis may lead to complications such as angina, syncope, or heart failure. The average survival is 2 to 3 years after the onset of symptoms [8][9][10],there is also a high risk of sudden death, which may occur without prior symptoms [8]. Sudden death is known to occur in less than 1% per year when patients with aortic stenosis are followed up prospectively [11]. Asymptomatic patients are treated conservatively, whereas corrective surgery (Aortic valvotomy or valve replacement) is generally recommended in patients with symptoms due to AS.
Complications
Possible complications for untreated aortic stenosis include:
- Arrhythmias.
- Endocarditis.
- Left-sided heart failure.
- Left ventricular hypertrophy (enlargement) caused by the extra work of pushing blood through the narrowed valve.
- Atrial fibrillation.
- Myocardial infarction.
- Angina.
- Fainting (syncope).
Prognosis
30% reduction in gradient is expected as the immediate result of surgical intervention. Patient survival after repeat BAV is higher than that of untreated patients.
References
- ↑ Faggiano P, Aurigemma GP, Rusconi C, Gaasch WH (1996). "Progression of valvular aortic stenosis in adults: literature review and clinical implications". Am Heart J. 132 (2 Pt 1): 408–17. PMID 8701905.
- ↑ Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA; et al. (2003). "Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography". J Am Soc Echocardiogr. 16 (7): 777–802. doi:10.1016/S0894-7317(03)00335-3. PMID 12835667.
- ↑ Cheitlin MD, Gertz EW, Brundage BH, Carlson CJ, Quash JA, Bode RS (1979). "Rate of progression of severity of valvular aortic stenosis in the adult". Am Heart J. 98 (6): 689–700. PMID 495418.
- ↑ Jonasson R, Jonsson B, Nordlander R, Orinius E, Szamosi A (1983). "Rate of progression of severity of valvular aortic stenosis". Acta Med Scand. 213 (1): 51–4. PMID 6829320.
- ↑ Peter M, Hoffmann A, Parker C, Lüscher T, Burckhardt D (1993). "Progression of aortic stenosis. Role of age and concomitant coronary artery disease". Chest. 103 (6): 1715–9. PMID 8404089.
- ↑ Rosenhek R, Binder T, Porenta G, Lang I, Christ G, Schemper M; et al. (2000). "Predictors of outcome in severe, asymptomatic aortic stenosis". N Engl J Med. 343 (9): 611–7. doi:10.1056/NEJM200008313430903. PMID 10965007.
- ↑ Vincentelli A, Susen S, Le Tourneau T, Six I, Fabre O, Juthier F; et al. (2003). "Acquired von Willebrand syndrome in aortic stenosis". N Engl J Med. 349 (4): 343–9. doi:10.1056/NEJMoa022831. PMID 12878741.
- ↑ 8.0 8.1 Ross J, Braunwald E (1968). "Aortic stenosis". Circulation. 38 (1 Suppl): 61–7. PMID 4894151.
- ↑ Kelly TA, Rothbart RM, Cooper CM, Kaiser DL, Smucker ML, Gibson RS (1988). "Comparison of outcome of asymptomatic to symptomatic patients older than 20 years of age with valvular aortic stenosis". Am J Cardiol. 61 (1): 123–30. PMID 3337000.
- ↑ Iivanainen AM, Lindroos M, Tilvis R, Heikkilä J, Kupari M (1996). "Natural history of aortic valve stenosis of varying severity in the elderly". Am J Cardiol. 78 (1): 97–101. PMID 8712130.
- ↑ Chizner MA, Pearle DL, deLeon AC (1980). "The natural history of aortic stenosis in adults". Am Heart J. 99 (4): 419–24. PMID 7189084.