[Spontaneous course of aortic valve lesions which do not have to be treated surgically]

Seventy-nine patients with aortic valve disease were studied invasively between 1966 and 1980 but were not operated upon because they were not symptomatic or the valve lesion was hemodynamically not severe enough. 65 patients were followed up for an average observation period of 7.8 years. Aortic stenosis was found in 11 patients, aortic insufficiency in 25 and combined aortic valve lesions in 29. Four patients died during the follow-up (2 sudden deaths, 2 from chronic heart failure). Eight patients underwent aortic valve replacement. Cumulative survival rate was 98% after 5 years and 92% after 10 years. Event-free rate (no deaths, no operation) was 100% in aortic stenosis, 83% in aortic insufficiency and 96% in combined valve lesions after 5 years, and 82%, 71% and 87% after 10 years. Patients with no cardiac events (group 1, n = 53) were initially less symptomatic (NYHA class 1.6 versus 2.3, p less than 0.01), had less dyspnea (36% versus 75%, p less than 0.01), less chest pain (21% versus 50%, p less than 0.05) and less frequent left ventricular hypertrophy in the ECG (25% versus 64%, p less than 0.01) than patients who died or were operated on during the follow-up (group 2, n = 12). Cardiac catheterization revealed lower left ventricular enddiastolic pressure in group 1 (12 versus 16 mm Hg, p less than 0.01) and a lower aortic regurgitant fraction (0.22 versus 0.37, p less than 0.02) than in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)