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[Diagnosis and treatment of aortic valve stenosis]

A Vogelgesang1, G Hasenfuß2, C Jacobshagen2

  • 1Herzzentrum - Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland. anja.vogelgesang@med.uni-goettingen.de.

Der Internist
|November 11, 2018
PubMed

Insights

Aortic valve stenosis (AS), a common heart valve disease, requires accurate diagnosis via echocardiography. Treatment for symptomatic AS is individualized, considering patient risk for surgical or transcatheter valve replacement.

Area of Science:

  • Cardiology
  • Valvular Heart Disease
  • Echocardiography

Background:

  • Aortic valve stenosis (AS) is the most prevalent valvular heart disease, with rapidly increasing mortality once symptomatic.
  • Accurate diagnosis and classification are crucial for effective management of AS.

Purpose of the Study:

  • To outline the diagnostic gold standard for aortic valve stenosis (AS).
  • To describe the classification of different AS types based on echocardiographic parameters.
  • To discuss the role of additional diagnostic tools and individualized treatment strategies for AS.

Main Methods:

  • Transthoracic echocardiography is the gold standard diagnostic tool.
  • Key measurements include maximum transvalvular velocity, mean transaortic pressure gradient, and aortic valve opening area.
  • Advanced imaging like dobutamine stress echocardiography, transesophageal echocardiography, and cardiac CT may be used.

Main Results:

  • AS is classified into high-gradient AS, low-flow low-gradient AS with reduced ejection fraction (<50%), and paradoxical low-flow low-gradient AS with preserved ejection fraction (≥50%).
  • Echocardiographic parameters guide the differentiation between these AS subtypes.

Conclusions:

  • Accurate echocardiographic assessment is essential for classifying AS severity and type.
  • Treatment decisions, including surgical or transcatheter valve replacement, are individualized by a multidisciplinary heart team based on patient risk and age.

Keywords:
Low-flow-low-gradient aortic stenosisRisk factorsSurgical aortic valve replacementTranscatheter aortic valve replacementTransthoracic echocardiography

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