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[Conduction disorders in aortic valve diseases]
Insights
Aortic valvulopathies frequently cause conduction disturbances, particularly in older patients or those with severe disease. These issues increase surgical risk but do not contraindicate necessary valve surgery.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Valvular Heart Disease
Context:
- Aortic valvulopathies, including stenosis and regurgitation, affect a significant patient population.
- Conduction disturbances are common complications in patients with aortic valve disease.
- Surgical intervention is often required for severe aortic valvulopathies.
Purpose:
- To investigate the incidence and characteristics of conduction disturbances in patients with aortic valvulopathies.
- To assess the impact of conduction disturbances on surgical risk and prognosis.
- To provide guidance on managing conduction disturbances in the context of aortic valve surgery.
Summary:
- A study of 304 patients with aortic valvulopathies revealed a high incidence of conduction disturbances (16% in aortic stenosis, 18.4% in aortic regurgitation).
- Conduction defects varied by valvulopathy type (intraventricular in stenosis, atrio-ventricular in regurgitation) and were highest in bacterial endocarditis (30%).
- Incidence correlated with age, calcifications, ventricular strain, coronary insufficiency, and disease severity, increasing surgical risk and worsening prognosis.
Impact:
- Conduction disturbances do not contraindicate aortic valve surgery and may necessitate pacemaker insertion.
- Management strategies must consider the potential need for cardiac pacing, especially in cases of infrahisian conduction defects.
- Hemodynamic evaluation requires preparedness for cardiac stimulation, particularly in patients with complete left bundle branch block.
Abstract:
Among 304 cases of aortic valvulopathies studied for surgical selection, the authors have found a high incidence of conduction disturbances (16% in aortic stenosis and 18,4% in aortic regurgitation). The conduction defects are mostly intraventricular among stenosis isolated or associated to regurgitation and mostly atrio-ventricular among pure aortic insufficiencies. The highest incidence (30%) being found in patients with bacterial endocarditis acute or healed. The incidence of conduction disturbances increases with age, with the presence of valvular calcifications, of left ventricular strain or failure, of coronary insufficiency and angina... practically with the duration and the severity of the valvular disease. Surgical risk is heavier and natural prognosis poorer in valvulopathies with conduction disturbances. But these disturbances never contraindicates surgery : it is sometimes necessary to insert a pacemaker with or without valvular replacement mostly in aortic stenosis with infrahisian conduction defects. During hemodynamic investigation of such cases one must be ready to stimulate the heart, particularly during right heart catheterization of patients with complete left bundle branch block.