Abstract
Chronic aortic valve disease involving stenosis, regurgitation or both is insidious and progressive. Severe valvular dysfunction may be present for years without symptoms, but functional deterioration is often rapid once congestive heart failure, angina or syncope with effort is present. As the severity of aortic stenosis may not be easy to assess clinically, the relative usefulness of various tests is considered in this paper. The difficulty with chronic aortic regurgitation lies not in diagnosing the problem but in detecting early left ventricular dysfunction in time to perform the surgery that can prevent further functional deterioration. Patients with significant aortic valve disease should undergo surgery when the important symptoms of dyspnea, angina or syncope with effort first appear. Surgery should also be considered in selected patients with aortic regurgitation in whom left ventricular function has diminished even without symptoms.
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Selected References
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- BERGERON J., ABELMANN W. H., VAZQUEZ-MILAN H., ELLIS L. B. Aortic stenosis; clinical manifestations and course of the disease; review of one hundred proved cases. AMA Arch Intern Med. 1954 Dec;94(6):911–924. doi: 10.1001/archinte.1954.00250060045004. [DOI] [PubMed] [Google Scholar]
- Bennett D. H., Evans D. W., Raj M. V. Echocardiographic left ventricular dimensions in pressure and volume overload. Their use in assessing aortic stenosis. Br Heart J. 1975 Sep;37(9):971–977. doi: 10.1136/hrt.37.9.971. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Borer J. S., Bacharach S. L., Green M. V., Kent K. M., Henry W. L., Rosing D. R., Seides S. F., Johnston G. S., Epstein S. E. Exercise-induced left ventricular dysfunction in symptomatic and asymptomatic patients with aortic regurgitation: assessment with radionuclide cineangiography. Am J Cardiol. 1978 Sep;42(3):351–357. doi: 10.1016/0002-9149(78)90927-x. [DOI] [PubMed] [Google Scholar]
- Campbell M. Calcific aortic stenosis and congenital bicuspid aortic valves. Br Heart J. 1968 Sep;30(5):606–616. doi: 10.1136/hrt.30.5.606. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Caulfield W. H., de Leon A. C., Jr, Perloff J. K., Steelman R. B. The clinical significance of the fourth heart sound in aortic stenosis. Am J Cardiol. 1971 Aug;28(2):179–182. doi: 10.1016/0002-9149(71)90367-5. [DOI] [PubMed] [Google Scholar]
- Eddleman E. E., Jr, Frommeyer W. B., Jr, Lyle D. P., Turner M. E., Jr, Bancroft W. H., Jr Critical analysis of clinical factors in estimating severity of aortic valve disease. Am J Cardiol. 1973 Jun;31(6):687–695. doi: 10.1016/0002-9149(73)90001-5. [DOI] [PubMed] [Google Scholar]
- Ettinger P. O., Frank M. J., Levinson G. E. Hemodynamics at rest and during exercise in combined aortic stenosis and insufficiency. Circulation. 1972 Feb;45(2):267–276. doi: 10.1161/01.cir.45.2.267. [DOI] [PubMed] [Google Scholar]
- Frank S., Johnson A., Ross J., Jr Natural history of valvular aortic stenosis. Br Heart J. 1973 Jan;35(1):41–46. doi: 10.1136/hrt.35.1.41. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Goldschlager N., Pfeifer J., Cohn K., Popper R., Selzer A. The natural history of aortic regurgitation. A clinical and hemodynamic study. Am J Med. 1973 May;54(5):577–588. doi: 10.1016/0002-9343(73)90115-0. [DOI] [PubMed] [Google Scholar]
- Gould L., Venkataraman K., Goswami M., DeMartino A., Gomprecht R. F. Right-sided heart failure in aortic stenosis. Am J Cardiol. 1973 Mar;31(3):381–383. doi: 10.1016/0002-9149(73)90272-5. [DOI] [PubMed] [Google Scholar]
- Henry W. L., Bonow R. O., Borer J. S., Ware J. H., Kent K. M., Redwood D. R., McIntosh C. L., Morrow A. G., Epstein S. E. Observations on the optimum time for operative intervention for aortic regurgitation. I. Evaluation of the results of aortic valve replacement in symptomatic patients. Circulation. 1980 Mar;61(3):471–483. doi: 10.1161/01.cir.61.3.471. [DOI] [PubMed] [Google Scholar]
- Hunt D., Baxley W. A., Kennedy J. W., Judge T. P., Williams J. E., Dodge H. T. Quantitative evaluation of cineaortography in the assessment of aortic regurgitation. Am J Cardiol. 1973 Jun;31(6):696–700. doi: 10.1016/0002-9149(73)90002-7. [DOI] [PubMed] [Google Scholar]
- Iskandrian A. S., Segal B. L., Wasserman L., Kimbiris D., Bemis C. E. Sudden death in severe aortic stenosis following cardiac catheterization. Cathet Cardiovasc Diagn. 1978;4(4):419–425. doi: 10.1002/ccd.1810040410. [DOI] [PubMed] [Google Scholar]
- Kennedy J. W., Doces J., Stewart D. K. Left ventricular function before and following aortic valve replacement. Circulation. 1977 Dec;56(6):944–950. doi: 10.1161/01.cir.56.6.944. [DOI] [PubMed] [Google Scholar]
- Lewis R. P., Bristow J. D., Griswold H. E. Exercise hemodynamics in aortic regurgitation. Am Heart J. 1970 Aug;80(2):171–176. doi: 10.1016/0002-8703(70)90164-x. [DOI] [PubMed] [Google Scholar]
- MITCHELL A. M., SACKETT C. H., HUNZICKER W. J., LEVINE S. A. The clinical features of aortic stenosis. Am Heart J. 1954 Nov;48(5):684–720. doi: 10.1016/0002-8703(54)90063-0. [DOI] [PubMed] [Google Scholar]
- Mennel R. G., Joyner C. R., Jr, Thompson P. D., Pyle R. R., Macvaugh H., 3rd The preoperative and operative assessment of aortic regurgitation. Cineaortography vs. electromagnetic flowmeter. Am J Cardiol. 1972 Mar;29(3):360–366. doi: 10.1016/0002-9149(72)90531-0. [DOI] [PubMed] [Google Scholar]
- Moraski R. E., Russell R. O., Jr, Mantle J. A., Rackley C. E. Aortic stenosis, angina pectoris, coronary artery disease. Cathet Cardiovasc Diagn. 1976;2(2):157–164. doi: 10.1002/ccd.1810020207. [DOI] [PubMed] [Google Scholar]
- Morton B. C., Troup W. J., Baird M. G., Keon W. J. Left ventricular outflow obstruction at multiple levels: occurrence in a single patient. Cathet Cardiovasc Diagn. 1980;6(4):431–437. doi: 10.1002/ccd.1810060413. [DOI] [PubMed] [Google Scholar]
- Nesje O. A. Severity of aortic stenosis assessed by carotid pulse recordings and phonocardiography. Acta Med Scand. 1978;204(4):321–330. doi: 10.1111/j.0954-6820.1978.tb08447.x. [DOI] [PubMed] [Google Scholar]
- Oakley C. M., Hallidie-Smith K. A. Assessment of site and severity in congenital aortic stenosis. Br Heart J. 1967 May;29(3):367–379. doi: 10.1136/hrt.29.3.367. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Roberts W. C. Anatomically isolated aortic valvular disease. The case against its being of rheumatic etiology. Am J Med. 1970 Aug;49(2):151–159. doi: 10.1016/s0002-9343(70)80070-5. [DOI] [PubMed] [Google Scholar]
- Roberts W. C., Perloff J. K., Costantino T. Severe valvular aortic stenosis in patients over 65 years of age. A clinicopathologic study. Am J Cardiol. 1971 May;27(5):497–506. doi: 10.1016/0002-9149(71)90412-7. [DOI] [PubMed] [Google Scholar]
- Ross J., Jr, Braunwald E. Aortic stenosis. Circulation. 1968 Jul;38(1 Suppl):61–67. doi: 10.1161/01.cir.38.1s5.v-61. [DOI] [PubMed] [Google Scholar]
- SEGAL J., HARVEY W. P., HUFNAGEL C. A clinical study of one hundred cases of severe aortic insufficiency. Am J Med. 1956 Aug;21(2):200–210. doi: 10.1016/0002-9343(56)90053-5. [DOI] [PubMed] [Google Scholar]
- Schwartz A., Vignola P. A., Walker H. J., King M. E., Goldblatt A. Echocardiographic estimation of aortic-valve gradient in aortic stenosis. Ann Intern Med. 1978 Sep;89(3):329–335. doi: 10.7326/0003-4819-89-3-329. [DOI] [PubMed] [Google Scholar]
- Spagnuolo M., Kloth H., Taranta A., Doyle E., Pasternack B. Natural history of rheumatic aortic regurgitation. Criteria predictive of death, congestive heart failure, and angina in young patients. Circulation. 1971 Sep;44(3):368–380. doi: 10.1161/01.cir.44.3.368. [DOI] [PubMed] [Google Scholar]
- Voelkel A. G., Kendrick M., Pietro D. A., Parisi A. F., Voelkel V., Greenfield D., Askenazi J., Folland E. D. Noninvasive tests to evaluate the severity of aortic stenosis. Limitations and reliability. Chest. 1980 Feb;77(2):155–160. doi: 10.1378/chest.77.2.155. [DOI] [PubMed] [Google Scholar]
- Young J. B., Quinones M. A., Waggoner A. D., Miller R. R. Diagnosis and quantification of aortic stenosis with pulsed Doppler echocardiography. Am J Cardiol. 1980 May;45(5):987–994. doi: 10.1016/0002-9149(80)90167-8. [DOI] [PubMed] [Google Scholar]
