[Aortic stenosis]

Aortic stenosis is the most frequent valvular heart disease. Its spectrum ranges from severe symptomatic stenosis on one side to aortic sclerosis without hemodynamic implications on the other. Inbetween it comprises the asymptomatic patients with severe but also those with moderate and mild aortic stenosis. The poor outcome of patients with severe symptomatic aortic stenosis has been well documented but current results of aortic valve replacement for acquired aortic stenosis have been shown to be excellent. In contrast, the management of asymptomatic patients with severe aortic stenosis remains a matter of controversy. Although a watchful waiting strategy is safe until symptoms develop in most patients, further risk stratification helps to identify patients who are likely to benefit from early elective surgery: the combination of a calcified valve with a rapid hemodynamic progression identifies a patient group at high-risk. There is also a role for exercise testing in asymptomatic patients with severe aortic stenosis for risk stratification and in unmasking symptoms. It should be considered that rapid progression from mild or moderate to severe stenosis is common and may be more rapid than previously assumed.