Aortic valve stenosis

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In medicine, aortic valve stenosis is an abnormality of the aortic valve in the heart.[1]

Diagnosis

A systematic review by the Rational Clinical Examination addresses diagnosis.[2] Since publication of the systematic review, a clinical prediction rule may help detecting moderate to severe aortic valve stenosis (defined as a valve area of 1.2 cm2or less, or a peak instantaneous gradient of 25 mm Hg or greater):[3]

  • If the heart murmur does not radiate to the right neck, moderate aortic stenosis was very unlikely
  • If the heart murmur has at least three of the following signs, moderate stenosis was likely:
    • slow carotid artery upstroke (other studies suggest more than 200 msec is abnormal[4])
    • reduced carotid artery volume
    • heart murmur loudest at the second right intercostal space
    • reduced intensity of the second heart sound

Grading the degree of stenosis

According to joint clinical practice guidelines by the American College of Cardiology and the American Heart Association:Cite error: Closing </ref> missing for <ref> tag

Surgery

According to the ACC/AHA guidelines:[5] Class I recommendations

  1. "AVR is indicated for symptomatic patients with severe AS."
  2. "AVR is indicated for patients with severe AS* undergoing coronary artery bypass graft surgery (CABG)."
  3. "AVR is indicated for patients with severe AS* undergoing surgery on the aorta or other heart valves."
  4. "AVR is recommended for patients with severe AS* and LV systolic dysfunction (ejection fraction less than 0.50). "

Class IIa recommendations

  1. "AVR is reasonable for patients with moderate AS* undergoing CABG or surgery on the aorta or other heart valves."

Class IIb recommendations

  1. "AVR may be considered for asymptomatic patients with severe AS* and abnormal response to exercise (e.g., development of symptoms or asymptomatic hypotension)."
  2. "AVR may be considered for adults with severe asymptomatic AS* if there is a high likelihood of rapid progression (age, calcification, and CAD) or if surgery might be delayed at the time of symptom onset."
  3. "AVR may be considered in patients undergoing CABG who have mild AS* when there is evidence, such as moderate to severe valve calcification, that progression may be rapid."
  4. "AVR may be considered for asymptomatic patients with extremely severe AS (aortic valve area less than 0.6 cm2, mean gradient greater than 60 mm Hg, and jet velocity greater than 5.0 m per second) when the patient’s expected operative mortality is 1.0% or less."

Prognosis

Risks factors have been studied.[6]

References

  1. ↑ Carabello BA. Clinical practice. Aortic stenosis. N Engl J Med. 2002 Feb 28;346(9):677-82. Review. No abstract available. PMID 11870246
  2. ↑ Etchells E, Bell C, Robb K (February 1997). "Does this patient have an abnormal systolic murmur?". JAMA : the Journal of the American Medical Association 277 (7): 564–71. PMID 9032164. [e] Full text at OVID
  3. ↑ Etchells E, Glenns V, Shadowitz S, Bell C, Siu S (October 1998). "A bedside clinical prediction rule for detecting moderate or severe aortic stenosis". Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine 13 (10): 699–704. PMID 9798818. PMC 1500900. [e] PubMed Central
  4. ↑ Flohr KH, Weir EK, Chesler E (May 1981). "Diagnosis of aortic stenosis in older age groups using external carotid pulse recording and phonocardiography". British heart journal 45 (5): 577–82. PMID 7236464. PMC 482567. [e]
  5. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named pmid16880336
  6. ↑ Rosenhek R, Binder T, Porenta G, Lang I, Christ G, Schemper M, Maurer G, Baumgartner H.Predictors of outcome in severe, asymptomatic aortic stenosis.N Engl J Med. 2000 Aug 31;343(9):611-7. PMID 10965007
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