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Coeval Trends in Aortic Stenosis: The Transformation to Transcather Gambit


The most common valvular heart disease in developed nations would be aortic stenosis which affects 3% of individuals above the age of 65 years [1]. 60 - 75% narrowing from the normal valve area makes the lesion haemodynamically significant. Currently degenerative causes take preponderance over rheumatic aetiology in developed countries. Sclerotic and radiation induced lesions are also noted [2]. Initial stages remain asymptomatic due to compensatory role played by left ventricular hypertrophy and atrial augmentation of preload [3]. Heart failure angina and syncope ensues with life expectancy being shortened to approximately 3 years unless the obstruction is relieved. Asymptomatic patients, serial Doppler echocardiography is done every six to 12 months if aortic stenosis is severe, every one to two years for moderate disease, and every three to five years for mild disease. Select few may benefit by interventions prior to onset of symptoms. Transcatheter interventions have revolutionized the treatment in high or prohibitive risk category is now being extended to the moderate risk group too. Subvalvular and supravalvuar pathologies are not included in this discussion. Management of associated conditions like hypertension, coronary artery disease and atrial fibrillation is also needed. Symptoms, severity and LV response to pressure load are current deciding factors on management strategy for aortic stenosis. It can affect 6/1000 new born infants and can be diagnosed as early as 16 weeks in-utero

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