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[Is the estimation of the progression of valvular aortic stenosis possible?]
C Piper1, R Bergemann, H D Schulte
1Kardiologische Klinik, Herzzentrum Nordrhein-Westfalen, Ruhr-Universität, Bad Oeynhausen. cpiper@hdz-nrw.ruhr-uni-bochum.de
Insights
Predicting aortic valvar stenosis (AVS) progression is crucial for cardiac surgery planning. Calcification extent and transaortic gradient changes help estimate AVS progression, aiding treatment decisions.
Area of Science:
- Cardiology
- Cardiac Surgery
- Valvular Heart Disease
Background And Objective:
It is of great importance to assess progression of aortic valvar stenosis (AVS) when cardiac surgery is planned for other indications when established criteria for aortic valve replacement are not fulfilled at that moment. These considerations have often been ignored in prospective planning of treatment, necessitating a second cardiac surgical intervention just a few years later. The aim of this study was to establish criteria for estimating the rate of progression of AVS.
Patients And Methods:
Clinical, echocardiographic and haemodynamic data were analysed for 169 patients with aortic valvar stenosis (169 men, 88 women; mean age at first cardiac catheterization [CC] 55.2 +/- 15.7 years, at second CC 63.4 +/- 15.6 years.
Results:
The degree of AVS increases exponentially in relation to the extent of calcification (graded 0-3) and the fall in transaortic gradient (TG), from a TG > 0.6 mmHg/ml stroke volume and can be sufficiently predictable for clinical purposes. But neither age, sex nor the aetiology/pathology of the valvar defect have a sustained influence on the progression of AVS.
Conclusions:
These data indicate that knowing the current reduction in TG and the degree of calcification makes it possible to assess the likely progression of previously asymptomatic AVS and thus greatly facilitate the decision of whether or not to combine aortic valve replacement with another indicated cardiac operation.