14 May

The Natural History and Rate of Progression of Aortic Stenosis: Conclusion

The concept of a dynamic aortic valve orifice area needs validation. If veritable, an assessment of valve pliability derived by Doppler-determined changes in the instantaneous orifice area may provide important clinical information with respect to the relationship of hemodynamic severity and clinical symptoms. In addition, it may prove to be a more sensitive marker of disease progression and one could speculate that a deterioration in the dynamic change in orifice area be a marker of impending “classically” determined hemodynamic deterioration.
It has been well established that in patients with acquired valvular aortic stenosis, the development of symptoms portends a poor prognosis. Therefore, it is unlikely that there will be another true natural history study as once a patient develops symptoms, surgical treatment will interrupt the natural course of the disease. canadian neightbor pharmacy

The decision of when to operate on patients with hemodynamically significant yet asymptomatic acquired valvular aortic stenosis is based on less than perfect data. Until the ideal prosthetic valve is developed, there will always be some debate on when to intervene surgically. The risks and benefits of conservative vs surgical therapy must be weighed in each individual patient. Unfortunately, our ability to predict the rate of progression in an individual patient is insufficient. The clinician, therefore, is faced with making a decision under some uncertainty, which is often very difficult. What evidence we do have tends to support a conservative approach to the asymptomatic patient. The greatest risk to the patient with asymptomatic or minimally symptomatic acquired valvular aortic stenosis may well be aortic valve surgery. Only with further experimentation will we be able to develop new conceptual models to enhance our clinical decision making.

Categories: Aortic Stenosis
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