Article: Asymptomatic adult patients with aortic stenosis: should they ever have aortic valve replacement?
The American heart hospital journal
2005 Volume 3, Issue 4, Page(s) 243–6; quiz 247–8
Abstract: ... calcification, an aortic valve area <0.8 cm, an annual rate of progression of aortic valve velocity of >/=0.3 m ...
| Abstract | Presently, conventional wisdom is that an asymptomatic patient, even with severe aortic stenosis (AS), can be followed medically. The basis for this recommendation is that sudden death as the first "symptom" in an asymptomatic patient is rare. Unfortunately, symptoms are subjective and can be ignored or explained away by both patient and physician, and once symptoms are recognized, sudden death accounts for at least one third of the deaths from AS in unoperated patients. There is evidence that once AS becomes severe, ischemia and fibrosis occur rapidly, setting up the possibility of heart failure and sudden death even after successful valve replacement. Aortic valve replacement should be performed before extensive fibrosis occurs. Multiple studies have shown that in severe AS, symptoms will occur rapidly when there is heavy valve calcification, an aortic valve area <0.8 cm, an annual rate of progression of aortic valve velocity of >/=0.3 m/sec, or a positive exercise stress test. These findings are excellent evidence that asymptomatic patients with severe AS and any of the above findings should be considered for aortic valve replacement. |
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| MeSH term(s) | Adult ; Aortic Valve/surgery ; Aortic Valve Stenosis/complications ; Aortic Valve Stenosis/diagnosis ; Aortic Valve Stenosis/physiopathology ; Aortic Valve Stenosis/surgery ; Death, Sudden, Cardiac/etiology ; Disease Progression ; Fibrosis ; Heart Failure/etiology ; Heart Failure/physiopathology ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; Humans ; Incidence ; Myocardium/pathology ; Practice Guidelines as Topic ; Prognosis |
| Language | English |
| Publishing date | 2005-12-02 |
| Publishing country | England |
| Document type | Journal Article ; Review |
| ZDB-ID | 2205029-2 |
| ISSN | 1541-9215 |
| ISSN | 1541-9215 |
| DOI | 10.1111/j.1541-9215.2005.04258.x |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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