Spontaneous progression of valvular aortic stenosis

In 11 adult patients with isolated valvular aortic stenosis, the progression of the disease was assessed by two heart catheterisations without intervening aortic valve surgery. Four patients had bicuspid valves, whereas the remaining seven were considered to have acquired aortic stenosis. Significant differences between the two catheterisations were found for left ventricular peak systolic pressure (LVPSP), left ventricular aortic mean pressure gradient (LV-AO gradient), and for aortic valve area (OA). The rate of progression varied considerably. In one case the pressure gradient increased 43 mm Hg in 68 months, whereas in another case it remained almost unchanged for 103 months. One patient developed aortic valve regurgitation. ECG, chest X-ray and phonocardiography gave only poor estimates of the degree of progression. Thus having established a mild aortic stenosis at heart catheterisation, recatheterisation usually remains necessary to give the final indication for operation.