Abstract
Sudden death is now an infrequent occurrence in severe aortic stenosis. However, an impressive increase in pulmonary arteriolar resistance has been found in some patients with end-stage aortic stenosis dying suddenly or deteriorating suddenly after catheterisation. Pulmonary hypertension does not seem to cause sudden death, but, in conjunction with decreased cardiac output, a critical reduction in aortic orifice area, and left ventricular failure, pulmonary hypertension identifies a population at significant risk. The rare finding of severe pulmonary hypertension in aortic stenosis should be considered an important marker for sudden death and in association with left ventricular failure may indicate an urgent need for valve replacement, regardless of the apparent clinical condition of the patient. In a small number of subjects catheterised postoperatively, increased pulmonary arteriolar resistance lessened rapidly.
Full text
PDF




Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- BRAUNWALD E., LAMBREW C. T., ROCKOFF S. D., ROSS J., Jr, MORROW A. G. IDIOPATHIC HYPERTROPHIC SUBAORTIC STENOSIS. I. A DESCRIPTION OF THE DISEASE BASED UPON AN ANALYSIS OF 64 PATIENTS. Circulation. 1964 Nov;30:SUPPL 4–119. doi: 10.1161/01.cir.29.5s4.iv-3. [DOI] [PubMed] [Google Scholar]
- Basu B., Cherian G., Krishnaswami S., Sukumar I. P., John S. Severe pulmonary hypertension in advanced aortic valve disease. Br Heart J. 1978 Nov;40(11):1310–1313. doi: 10.1136/hrt.40.11.1310. [DOI] [PMC free article] [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]
- GORLIN R., HAYNES F. W., GOODALE W. T., SAWYER C. G., DOW J. W., DEXTER L. Studies of the circulatory dynamics in mitral stenosis. II. Altered dynamics at rest. Am Heart J. 1951 Jan;41(1):30–45. doi: 10.1016/0002-8703(51)90003-8. [DOI] [PubMed] [Google Scholar]
- GORLIN R., McMILLAN I. K., MEDD W. E., MATTHEWS M. B., DALEY R. Dynamics of the circulation in aortic valvular disease. Am J Med. 1955 Jun;18(6):855–870. doi: 10.1016/0002-9343(55)90169-8. [DOI] [PubMed] [Google Scholar]
- Kirsh M. M., Orvald T., Preston T., Kahn D. Pulmonary hypertension--a complication of aortic valve disease. Mich Med. 1970 Jan;69(1):33–35. [PubMed] [Google Scholar]
- Lee S. J., Jonsson B., Bevegård S., Karlöf I., Aström H. Hemodynamic changes at rest and during exercise in patients with aortic stenosis of varying severity. Am Heart J. 1970 Mar;79(3):318–331. doi: 10.1016/0002-8703(70)90419-9. [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]
- Matthews A. W., Barritt D. W., Keen G. E., Belsey R. H. Preoperative mortality in aortic stenosis. Br Heart J. 1974 Jan;36(1):101–103. doi: 10.1136/hrt.36.1.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
- PIRINCCI A., KASS I., DENST J., HOFFMAN M. S. Severe reactive pulmonary hypertension secondary to aortic stenosis. Am J Med Sci. 1961 Mar;241:343–349. doi: 10.1097/00000441-196103000-00009. [DOI] [PubMed] [Google Scholar]
- SMITH R. C., BURCHELL H. B., EDWARDS J. E. Pathology of the pulmonary vascular tree. IV. Structural changes in the pulmonary vessels in chronic left ventricular failure. Circulation. 1954 Dec;10(6):801–808. doi: 10.1161/01.cir.10.6.801. [DOI] [PubMed] [Google Scholar]
- TAKEDA J., WARREN R., HOLZMAN D. PROGNOSIS OF AORTIC STENOSIS; SPECIAL REFERENCE TO INDICATIONS FOR OPERATIVE TREATMENT. Arch Surg. 1963 Dec;87:931–936. doi: 10.1001/archsurg.1963.01310180047009. [DOI] [PubMed] [Google Scholar]
- Trell E. Pulmonary hypertension in disorders of the left heart. Observations in a catheterization material. Scand J Clin Lab Invest. 1973 Jun;31(4):409–418. doi: 10.3109/00365517309084325. [DOI] [PubMed] [Google Scholar]
- WOOD P. An appreciation of mitral stenosis: II. Investigations and results. Br Med J. 1954 May 15;1(4871):1113–1124. doi: 10.1136/bmj.1.4871.1113. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Walston A., Peter R. H., Morris J. J., Kong Y., Behar V. S. Clinical implications of pulmonary hypertension in mitral stenosis. Am J Cardiol. 1973 Oct;32(5):650–655. doi: 10.1016/s0002-9149(73)80058-x. [DOI] [PubMed] [Google Scholar]
