Hemodynamic progression of adult valvular aortic stenosis

Hemodynamic progression of valvular aortic stenosis was studied in 54 patients who had serial cardiac catheterizations. There were 47 men and 7 women with a mean age of 61.2 years. The time interval between studies was 4.4 years (range, 0.4-12.2). Associated coronary artery disease was present in 37 patients (69%). The initial mean aortic valve area (Hakki's formula) was 1.26 cm2 (range, 0.66-2.85), and the aortic valve area at last follow-up was 0.77 cm2 (range, 0.29-1.95), with mean reduction of 0.49 cm2. The mean peak systolic gradient increased from 23.3 +/- 15.1 mm Hg at initial study to 52.6 +/- 27.5 mm Hg at last study, a mean increase of 29.3 +/- 23.6 mm Hg. Patients with no or mild left ventricular impairment and no or mild coronary artery disease are more likely to have progression than patients with more severe left ventricular impairment or coronary artery disease (P less than 0.05). Aortic valve replacement for progressive aortic stenosis was required at a later date after coronary artery bypass grafting in a small group of nine patients. In this small group, there was high intraoperative mortality of 33%.