RESUMEN
Calcified "degenerative" aortic stenosis is currently the most common valvulopathy in industrialised countries. In the course of the last decade, experimental studies have allowed a better understanding of the physiopathology of this vavlulopathy. The latest development is the evidence for the initiation and progression of this disease, similar to those described for atherosclerosis. Lipid disturbances, in particular hypercholesterolaemia, constitute an important factor in the initiation of valvular lesions, but also in aortic orifice calcification. Certain preliminary clinical studies are in favour of the significance of statins for slowing the progression of aortic stenosis. This potential beneficial effect requires confirmation by randomised prospective studies and raises hopes for medical therapy in order to avoid the evolution of ordinary aortic sclerosis into tight calcified aortic stenosis.
Asunto(s)
Estenosis de la Válvula Aórtica/tratamiento farmacológico , Estenosis de la Válvula Aórtica/fisiopatología , Calcinosis/fisiopatología , Enfermedad de la Arteria Coronaria/fisiopatología , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéuticoRESUMEN
In the presence of symptomatic aortic insufficiency, the indication for surgery is accepted. On the other hand, when the patient is asymptomatic, there is hesitation between intervening too early because of the operative risk and complications of valvular prostheses, and operating too late because of the progressive spontaneous risk of aortic parietal complications, sudden death or irreversible left ventricular dysfunction. Before any discussion, it is logical to verify the asymptomatic character of the patient with a stress test. On knowing the severity of the aortic insufficiency, which is usually confirmed by Doppler echocardiography, the decision is based partly on the left ventricular effects and the ascending aortic diameters, and partly on the operative risk modified by age and associated pathologies. In this article, drawing on the data in the literature we set out to discuss the operative indications in asymptomatic chronic aortic insufficiency.
Asunto(s)
Insuficiencia de la Válvula Aórtica/fisiopatología , Insuficiencia de la Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/mortalidad , Ecocardiografía Doppler , Prueba de Esfuerzo , Humanos , Reproducibilidad de los Resultados , Análisis de SupervivenciaRESUMEN
The convergence zone method is currently used routinely to quantify valvular regurgitation, particularly mitral insufficiency, but also aortic and tricuspid regurgitation. It is quick to perform, requires relatively little training and remains valid in the presence of atrial fibrillation and in the association of regurgitation-stenosis. It relies on the measurement of output at the level of an isovelocity hemisphere and allows calculation of the regurgitant orifice surface (SOR) and the regurgitant volume per beat (VR). It is reserved for severe regurgitation corresponding to angiographic grade 4: SOR > 40 mm2 and VR > 60 ml for mitral insufficiency, SOR > 30 mm2 and VR > 60 ml for aortic insufficiency, and SOR > 40 mm2 and VR > 40 ml for tricuspid insufficiency.