ITEMS IN AFP WITH MESH TERM:
Aortic Valve Stenosis
ABSTRACT: People with valvular heart disease are living longer, with less morbidity, than ever before. Advances in surgical techniques and a better understanding of timing for surgical intervention account for increased rates of survival. Echocardiography remains the gold standard for diagnosis and periodic assessment of patients with valvular heart disease. Generally, patients with stenotic valvular lesions can be monitored clinically until symptoms appear. In contrast, patients with regurgitant valvular lesions require careful echocardiographic monitoring for left ventricular function and may require surgery even if no symptoms are present. Aside from antibiotic prophylaxis, very little medical therapy is available for patients with valvular heart disease; surgery is the treatment for most symptomatic lesions or for lesions causing left ventricular dysfunction even in the absence of symptoms.
Aortic Stenosis: Diagnosis and Treatment - Article
ABSTRACT: Aortic stenosis is the most important cardiac valve disease in developed countries, affecting 3 percent of persons older than 65 years. Although the survival rate in asymptomatic patients with aortic stenosis is comparable to that in age- and sex-matched control patients, the average overall survival rate in symptomatic persons without aortic valve replacement is two to three years. During the asymptomatic latent period, left ventricular hypertrophy and atrial augmentation of preload compensate for the increase in afterload caused by aortic stenosis. As the disease worsens, these compensatory mechanisms become inadequate, leading to symptoms of heart failure, angina, or syncope. Aortic valve replacement should be recommended in most patients with any of these symptoms accompanied by evidence of significant aortic stenosis on echocardiography. Watchful waiting is recommended for most asymptomatic patients, including those with hemodynamically significant aortic stenosis. Patients should be educated about symptoms and the importance of promptly reporting them to their physicians. Serial Doppler echocardiography is recommended annually for severe aortic stenosis, every one or two years for moderate disease, and every three to five years for mild disease. Cardiology referral is recommended for all patients with symptomatic aortic stenosis, those with severe aortic stenosis without apparent symptoms, and those with left ventricular dysfunction. Many patients with asymptomatic aortic stenosis have concurrent cardiac conditions, such as hypertension, atrial fibrillation, and coronary artery disease, which should also be carefully managed.