Aortic stenosis natural history, complications and prognosis
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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: Claudia P. Hochberg, M.D. [2], Abdul-Rahman Arabi, M.D. [3], Keri Shafer, M.D. [4], Mohammed A. Sbeih, 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].
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.