Aortic stenosis
Aortic stenosis is obstruction to left ventricular outflow from a narrowed aortic valve, most often calcific degeneration in older adults or a bicentric bicuspid valve earlier in life. Symptoms of angina, syncope, or heart failure mark a poor prognosis, and severe symptomatic disease is treated with valve replacement (surgical or transcatheter).
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What this article covers
- Overview
Definition: aortic stenosis is obstruction to left ventricular outflow caused by narrowing of the aortic valve, producing a pressure overload on the left ventricle.
- Epidemiology
The most common valve lesion requiring intervention in developed countries.
- Risk factors
Age and calcific degeneration. Congenital bicuspid aortic valve.
- Pathophysiology
Progressive obstruction: valve narrowing raises the transvalvular gradient and left ventricular systolic pressure.
- Clinical features
Exertional angina, syncope, and dyspnea (the classic symptom triad).
- Differential diagnosis
Aortic sclerosis: valve thickening with a systolic murmur but no significant obstruction, distinguished by a jet velocity below 2.5 m/s and a normal gradient (Aortic sclerosis).
- Diagnosis
Establish and grade severity with echocardiography measuring valve area, mean gradient, and jet velocity: the diagnostic basis is transthoracic echocardiography, with severe stenosis defined by an…
- Management
First-line, replace the valve in severe symptomatic disease: aortic valve replacement, surgical or transcatheter (TAVR), is the definitive treatment and is indicated once severe stenosis becomes…
- Complications
Heart failure and pulmonary edema. Syncope and sudden cardiac death.
- Prognosis
Excellent while asymptomatic, but survival falls sharply once symptoms develop (a matter of a few years untreated).
- Prevention
Manage atherosclerotic risk factors: blood pressure below 130/80 mmHg, lipids, and smoking cessation.
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Related articles
- Aortic regurgitation
Aortic regurgitation is diastolic backflow of blood from the aorta into the left ventricle from valve or aortic root disease. Chronic disease causes volume overload with a wide pulse pressure and a decrescendo diastolic murmur, while acute severe regurgitation is a surgical emergency; severe symptomatic or decompensating disease is treated with valve replacement.
- Aortic sclerosis
Aortic sclerosis is calcific thickening of the aortic valve without significant obstruction, producing a systolic murmur but no meaningful gradient. It shares risk factors with atherosclerosis, is a marker of cardiovascular risk, and can progress to aortic stenosis, so management is cardiovascular risk-factor control and echocardiographic surveillance.
- Heart failure
Heart failure is a clinical syndrome of impaired cardiac filling or ejection causing congestion and reduced perfusion, classified by ejection fraction. Diagnosis integrates symptoms, signs, natriuretic peptides, and echocardiography, and treatment of reduced-ejection-fraction disease is quadruple guideline-directed therapy, with device therapy and cause-specific management.
- Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy is an autosomal dominant sarcomere disease causing unexplained left ventricular hypertrophy, often with dynamic left ventricular outflow tract obstruction, and is a leading cause of sudden cardiac death in young people. Diagnosis is by echocardiography or cardiac MRI showing unexplained hypertrophy, and management includes negative inotropes, obstruction relief, and ICD placement for high sudden-death risk.
- Mitral regurgitation
Mitral regurgitation is systolic backflow from the left ventricle into the left atrium, classified as primary (valve disease) or secondary (ventricular or annular disease). Chronic disease causes volume overload with an apical holosystolic murmur, while acute severe regurgitation causes pulmonary edema; severe primary disease is treated with valve repair or replacement.
- Pulmonic stenosis
Pulmonic stenosis is obstruction to right ventricular outflow from a narrowed pulmonary valve, usually congenital. It causes a systolic ejection murmur with an ejection click and, when severe, right ventricular hypertrophy and failure; severe or symptomatic disease is treated effectively with balloon valvuloplasty.