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Aortic Valve Disease

  • Chapter
Cardiovascular Medicine

Abstract

  • Calcific disease is the major cause of aortic stenosis.

  • Bicuspid aortic valves lead to aortic stenosis in approximately one half of patients who are born with them.

  • The classic symptoms of valvular aortic stenosis, angina, syncope, and dyspnea represent a major inflection in the natural history of the disease and indicate the need for surgical correction, and in the absence of surgical therapy an increased risk of sudden death.

  • The mainstay of diagnosis of valvular aortic stenosis is the echocardiogram, which, together with Doppler, provide an excellent estimate of the severity of valvular aortic stenosis.

  • Patients with low cardiac outputs and some valvular aortic stenosis and those with severe valvular stenosis and reduced left ventricle (LV) function can often be distinguished by a dobutamine infusion test with echocardiography.

  • Aortic regurgitation is caused by pathology of the aortic valve leaflets or of the aortic root.

  • An Austin Flint murmur (apical diastolic rumble) indicates severe aortic insufficiency.

  • Vasodilators may reduce LV volume or delay the development of symptoms in patients with aortic regurgitation (AR).

  • Surgical correction of AR is needed when the amount of regurgitation is severe and either symptoms of congestive heart failure (CHF) or angina develop or with evidence of decline in LV function, for example, a fall in the LV ejection fraction (LVEF) below 0.55 or the LV is unable to contract down to 50 to 55 mm Hg at the end of systole.

  • Acute AR, such as occurs following perforation of an aortic leaflet by infective endocarditis, is a potentially life-threatening emergency that often requires very early surgical correction.

  • Appetite-suppressant drugs may cause pulmonary hypertension and left ventricular valvular lesions, including aortic and mitral valve insufficiency.

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Authors and Affiliations

  1. Department of Medicine, Houston Veterans Affairs Medical Center, Houston, TX, USA

    Blase A. Carabello MD

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  1. Blase A. Carabello MD
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Editors and Affiliations

  1. The University of Texas Health Science Center in Houston, Houston

    James T. Willerson MD (President, President-Elect and Medical Director) (President, President-Elect and Medical Director)

  2. Texas Heart Institute, Houston, TX, USA

    James T. Willerson MD (President, President-Elect and Medical Director) (President, President-Elect and Medical Director)

  3. Department of Cardiology, University of Maastricht, Masstricht, The Netherlands

    Hein J. J. Wellens MD (Emeritus Professor) (Emeritus Professor)

  4. Rasmussen Center for Cardiovascular Disease Prevention Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA

    Jay N. Cohn MD (Professor of Medicine and Director) (Professor of Medicine and Director)

  5. Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA

    David R. Holmes Jr. MD (Consultant, Professor of Medicine and Scripps Professor) (Consultant, Professor of Medicine and Scripps Professor)

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Carabello, B.A. (2007). Aortic Valve Disease. In: Willerson, J.T., Wellens, H.J.J., Cohn, J.N., Holmes, D.R. (eds) Cardiovascular Medicine. Springer, London. https://doi.org/10.1007/978-1-84628-715-2_15

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