Monckeberg, J. G. (1904).
Virchows Archiv fur athologische
Anatomie und Physiology undfur
Klinische Medizin, 176, 472.
Dry, T. J., and Willius F. A.: Am. Heart Journal, 17:138-157 (Feb.), 1939.
Dry, T. J., and Willius F. A.
Am. Heart Journal, 17:138-157
(Feb.), 1939.
Causes of death (n=106):
Congestive heart failure, 32 patients (3o.5%)
Sudden death, 18 patients (17%)
Infective endocarditis, 5 patients (4.7%)
Acute coronary occlusion, 1 patient (0.9%)
Non cardiac cause, 50 patients (47%).
Dry, T. J., and Willius F. A.: Am. Heart Journal, 17:138-157 (Feb.), 1939.
Majority of patients who died when the syndrome of
congestive heart failure was present responded to
therapy in a rather disappointing manner ...
Dry, T. J., and Willius F. A.: Am. Heart Journal, 17:138-157 (Feb.), 1939.
1947 - Zimmerman discovered the technique of left
heart cardiac catheterization.
He was later awarded the Nobel Prize for combined
cardiac catheterization.
The evaluation of the natural history of aortic stenosis
has been difficult, because
the development of objective means for assessment of
its severity by left heart catheterization, and
the initial attempts at operative treatment,
occurred almost simultaneously.
The natural course of aortic stenosis was assembled
from clinical and postmortem studies largely from
before 1955, and
from a few more recent analyses that are supported by
hemodynamic information.
Townsend CM, et al. Sabiston Textbook of Surgery. 18th ed. Saunders; 2008:1841-1844.
An estimated 46,397 aortic valve replacements (AVR)
were performed.
In-hospital mortality occurred in
4.3% of first-time isolated AVR and
6.4% overall.
Aortic stenosis. Blase A Carabello, Walter J Paulus. Lancet 2009; 373: 95666
Many patients with limited or no symptoms yet
hemodynamically significant aortic stenosis are being
identified with the routine use of echo and cardiac
cath.
The dilemma is how best to treat these patients.
180 patients with valvular AS followed up for 25 years.
Aortic stenosis. Blase A Carabello, Walter J Paulus. Lancet 2009; 373: 95666
Risk stratification might incorporate
Jet velocity,
Progression of valvular narrowing,
Response to exercise testing,
Co-morbidity,
Abnormally raised biomarkers,
Presence of ventricular dysfunction,
Degree of valvular calcification etc.
Aortic stenosis. Blase A Carabello, Walter J Paulus. Lancet 2009; 373: 95666
128 consecutive patients with asymptomatic, severe
aortic stenosis.
Followed up for a mean of 2218 months.
End point: Death (8 patients) or valve replacement
necessitated by the development of symptoms (59
patients).
Circulation. 2005;111:3290-3295.
Predictors of
symptom
development
AV area
LVH.
Circulation.
2005;111:3290-3295.
Predictors of all-
cause mortality.
Age
CRF
Inactivity
AV velocity
Circulation.
2005;111:3290-3295.
Most patients with asymptomatic, hemodynamically
significant AS will develop symptoms within 5 years.
Circulation. 2005;111:3290-3295.
107 patients with asymptomatic aortic stenosis
followed up for 24 months.
Predefined end points:
Death or
AVR if symptoms or positive EST.
Circulation. 2009;120:69-75.
Circulation. 2009;120:69-75.
Score=[peak velocity (m/s)x2]+(natural logarithm of
B-type natriuretic peptidex1.5)+1.5 (if female sex).
Circulation. 2009;120:69-75.
116 consecutive asymptomatic patients with median
follow up of 41 months.
Very severe isolated aortic stenosis defined by a peak
aortic jet velocity (AV-Vel)5.0 m/s.
End points: Cardiac death or indication for aortic valve
replacement according to the accepted guidelines.
Circulation. 2010;121:151-156.
96 events
AVR in 90 patients and
cardiac deaths in 6 patients.
Sudden death without symptoms (n=1).
Congestive heart failure (n=4)
Myocardial infarction (n=1).
Circulation. 2010;121:151-156.
Circulation. 2010;121:151-156.
Circulation. 2010;121:151-156.
Patients with asymptomatic very severe aortic stenosis
have a poor prognosis with a high event rate and a risk
of rapid functional deterioration.
Circulation. 2010;121:151-156.
The peak gradient changed by +12 mm Hg/yr (-10 to
+34 mm Hg) and the
mean gradient changed by +8 mm Hg/yr (-7 to +23
mm Hg).
Mean reduction in aortic valve area of -0.1 cm2/yr (0.0
to -0.5 cm2).