Aortic stenosis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Aortic stenosis is obstruction of blood flow across the aortic valve due to aortic valve fibrosis and calcification. It is usually preceded by aortic sclerosis, often suspected by the presence of an early-peaking, systolic ejection murmur, and confirmed by echocardiography.
Following a decades-long subclinical period, presentation typically includes fatigue, decreased exercise capacity, exertional dyspnea, exertional chest pain (angina), syncope, and heart failure.
Characteristic murmur is systolic, mid-to-late peaking with a crescendo-decrescendo pattern, and radiates to the carotids.
Doppler echo is essential to the diagnosis and will show a pressure gradient across the stenotic aortic valve.
Treatment of severe aortic stenosis with either a transcatheter or surgical valve prosthesis should be based primarily on symptoms or reduced ventricular systolic function. Earlier intervention may be considered if indicated by results of exercise testing, biomarkers, rapid progression, or the presence of very severe stenosis.

Bicuspid and trileaflet aortic valves with severe calcification following surgical excision

From the collection of David Liff, MD, Emory University Hospital; used with permission

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Definition

Epidemiology

Etiology

Pathophysiology

Images

Bicuspid and trileaflet aortic valves with severe calcification following surgical excision
The systolic crescendo-decrescendo murmur of aortic stenosis
ECG showing changes associated with left ventricular hypertrophy
Transesophageal echocardiogram showing the left ventricle outflow tract (LVOT), the aorta (Ao), and nearly immobile leaflets (arrows) of a severely stenotic aortic valve
Balloon valvuloplasty fluoroscopy film that demonstrates valvuloplasty balloon inflated across a calcified aortic valve

Citations

Key Articles

Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2021 Feb 2;143(5):e72-227.[Full Text]
National Institute for Health and Care Excellence. Heart valve disease presenting in adults: investigation and management. Nov 2021 [internet publication].[Full Text]
Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2022 Feb 12;43(7):561-632.[Full Text]

Other Online Resources

Society of Thoracic Surgeons: risk calculator

Referenced Articles

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