Risk Keys

In aortic sclerosis, valve leaflets are abnormally thickened but obstruction to outflow is minimal.

Aortic stenosis is distinguished from aortic sclerosis by the degree of valve impairment causing outflow obstruction. With outflow velocity of > 2.5 m / sec, rule out AS.

Once symptoms occur significant or even critical disease is present.

When cardiac output and LV ejection fraction decrease, exercise performance declines.

Approximately 85% of patients with severe aortic stenosis show wall thickening of 1.3 cm or more.

Average increase of peak gradient across the valve ranges from 7-15 mm Hg / yr.

Valve area decrease ranges from 0.02 cm² / yr to as much as 0.3 cm² / yr.

With peak systolic pressure gradient of 20 mmHg or more echocardiographic follow up within the past 12 months is desirable.

The Ross procedure involves replacement of the aortic valve with the patient’s own pulmonary valve (autograft) which in turn is replaced with a cadaveric valve (homograft). This repair does not require anticoagulation. Results are as good or better than AVR alone.

Beware: in AS with low EF the outflow velocity underestimates the actual severity of disease (due to the decreased cardiac output).