Aortic stenosis from the perspective of the current guidelines

Abstract

Aortic stenosis (AS) is one of the most common valvular diseases encountered in clinical practice. It is most frequently caused by degenerative aortic valve fibrosis and calcification, and in a lesser number of cases by the calcification of congenital deformed aortic valve (bicuspid); it may occasionally develop after rheumatic fever. Valve fibrosis and calcification lead to progressive valve restriction, obstruction and increased afterload with left ventricle remodelling for normalization of wall tension and cardiac output. During time, such hypertrophic and fibrotic myocardium deteriorates, resulting in heart failure. Generally, current guidelines of the European Society of Cardiology (ESC) recommend aortic valve replacement (AVR) when the aortic valve is severely stenotic and the patient is symptomatic. Most asymptomatic patients with severe AS should be managed conservatively, except for those with systolic LV dysfunction, an abnormal exercise test, very severe aortic stenosis, severe valve calcification, markedly elevated cardiac biomarkers, and severe pulmonary hypertension without other explanation. This article will review our current understanding of the pathophysiology of AS and provide detailed information about clinical presentation, diagnostic procedures, disease course, and different treatment strategies for various groups of these patients.