AORTIC VALVE STENOSIS

Mónica Delgado

Aortic valve stenosis is a disease of the heart valves in which the opening of the aortic valve is narrowed. The aortic valve is the valve between the left ventricle of the heart and the aorta.

Aortic stenosis is most commonly caused by age-related progressive calcification of a normal (three-leafed) aortic valve (>50% of cases) mean age 65 to 70 years old - most common cause.

Other causes include calcification of a congenital bicuspid aortic valve most common cause and acute rheumatic fever post-inflammatory.

When the opening of the aortic valve becomes narrowed or constricted ( stenotic ), the blood can't be pumped adequately and the pressure in the left ventricle increases. Initially, the LV compensates by thickening its walls (myocardial hypertrophy) in order to maintain adequate pumping pressure. In the later stages, the left ventricle dilates, the wall thins, and the systolic function deteriorates.

Symptoms related to aortic stenosis depend on the degree of valve stenosis.

Symptoms usually are manifest in those with severe aortic stenosis. The initial presenting symptoms include progressive shortness of breath on exertion , which may be so subtle that the patient is unaware of them.

More worrisome symptoms include syncope, chest pain and sudden death.

Aortic stenosis is most often diagnosed when it is asymptomatic and can sometimes be detected during routine examination of the heart and circulatory system. There may also be a noticeable delay between the first heart sound (on auscultation ) and the corresponding pulse in the carotid artery (so-called 'apical-carotid delay').

MEDICAL

In general, any medical therapy has relatively poor effect in treating aortic stenosis.

Since calcific aortic stenosis shares many pathological features and risk factors with atherosclerosis , and since atherosclerosis may be prevented and/or reversed by cholesterol lowering, there has been interest in attempting to modify the course of calcific aortic stenosis by cholesterol lowering with statin drugs. Although a number of small, observational studies demonstrated an association between lowered cholesterol and decreased progression, and even regression, of calcific aortic stenosis.

ISSUE IN ECUADOR

Approximately 2% of people over the age of 65, 3% of people over age 75, and 4% percent of people over age 85 have aortic valve stenosis.The prevalence is increasing with the aging population.

In the new born, abnormalities of the left ventricle, the aortic valve or other heart and aortic abnomalities may lead the Ductus Ateriosus remaining open, or the Duct may remain open with no other abnormality.

There is no medical treatment for aortic stenosis. Symptoms need assessment for surgery, severe symptoms may need urgent surgery.

In Heyde's syndrome , aortic stenosis is associated with angiodysplasia of the colon . The stenosis causes a form of von Willebrand disease by breaking down its associated coagulation factor ( factor VIII -associated antigen, also called von Willebrand factor ), due to increased turbulence around the stenosed valve.