Aortic stenosis

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.

Choice of intervention should be a shared decision-making process, taking account of lifetime risks and benefits associated with the type of approach (transcatheter versus surgical) and type of valve (mechanical vs. bioprosthetic).

Following valve replacement, patients are subject to the complications of prosthetic valves.

Aortic stenosis (AS) is a degenerative, pathologic narrowing of the aortic valve, leading to symptomatic obstruction of blood flow out of the left ventricle. It is a progressive disease that often follows aortic sclerosis (defined as aortic valve thickening without flow limitation).