Table Of ContentAORTIC VALVE STENOSIS –
CURRENT VIEW ON
DIAGNOSTICS AND
TREATMENT
Edited by Petr Šantavý
Aortic Valve Stenosis – Current View on Diagnostics and Treatment
Edited by Petr Šantavý
Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia
Copyright © 2011 InTech
All chapters are Open Access articles distributed under the Creative Commons
Non Commercial Share Alike Attribution 3.0 license, which permits to copy,
distribute, transmit, and adapt the work in any medium, so long as the original
work is properly cited. After this work has been published by InTech, authors
have the right to republish it, in whole or part, in any publication of which they
are the author, and to make other personal use of the work. Any republication,
referencing or personal use of the work must explicitly identify the original source.
Statements and opinions expressed in the chapters are these of the individual contributors
and not necessarily those of the editors or publisher. No responsibility is accepted
for the accuracy of information contained in the published articles. The publisher
assumes no responsibility for any damage or injury to persons or property arising out
of the use of any materials, instructions, methods or ideas contained in the book.
Publishing Process Manager Alenka Urbancic
Technical Editor Teodora Smiljanic
Cover Designer Jan Hyrat
Image Copyright Floris Slooff, 2011. Used under license from Shutterstock.com
First published September, 2011
Printed in Croatia
A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from [email protected]
Aortic Valve Stenosis – Current View on Diagnostics and Treatment,
Edited by Petr Šantavý
p. cm.
978-953-307-628-7
free online editions of InTech
Books and Journals can be found at
www.intechopen.com
Contents
Preface VII
Chapter 1 Congenital Aortic Stenosis in Childhood 1
David Crespo and Nagib Dahdah
Chapter 2 Geriatric Aspects of Aortic Stenosis 35
Fatih Tufan, Fahrettin Öz, Ömer A Sayın and Hüseyin Oflaz
Chapter 3 Anaesthetic Considerations
for Patients with Severe Aortic Stenosis 67
Subhamay Ghosh, Lajos Bogar and Ahmed Sabry
Chapter 4 Operative Management – Patient-Prosthesis Mismatch 85
Koji Tsutsumi
Chapter 5 Patient-Prosthesis Mismatch
After Aortic Valve Replacement 95
Pierre Wauthy and Sophie G. Malekzadeh-Milani
Chapter 6 Pharmacologic and Non-Pharmacologic Treatment
of Chronic Atrial Fibrillation – With Special Reference to
Valvular Atrial Fibrillation in Rheumatic Heart Disease 113
Mohan Nair, Sanjeeb Patra and Vanita Arora
Chapter 7 Trends in Degenerative Aortic Disease: Novel Alternative
Therapies for the Treatment of Severe Aortic Stenosis 129
Javier Gualis, Alejandro Diego,
Antonio de Miguel and Mario Castaño
Preface
Aortic stenosis is a major health problem with large personal and economic impact. In
the last decades there has been a trend of worldwide aging, and diseases which are
common in elderly people will take an important place in clinical practice. Aortic
stenosis affects 3-5 percent of persons older than 65 years and leads to greater
morbidity and mortality than other cardiac valve diseases. Currently, aortic stenosis is
the most frequent heart valve disease in industrialized countries and its prevalence
increases with age. Thus with the prolongation of life expectancy, the population of
patients with aortic stenosis is expected to grow in the future. The etiology of this
disease is changing and is more precisely specified. Diagnostics is changing with new
trends and technical developments in echocardiography. Guidelines and indications
for aortic valve replacement are changing thanks to new trends in anesthesiology,
surgery and mini-invasive approaches. Patients previously considered too old or ill
are now indicated for aortic valve replacement procedures.
The approach and management of isolated aortic valve stenosis between fetal life and
late adolescence is discussed in the first chapter. Bicuspid aortic valve as a most
common form of congenital valve stenosis, is also described. Since approximately 2%
of people over the age of 65, 3% of people over the age of 75, and 4% of people over
the age of 85 have the disorder, important geriatric aspects of aortic stenosis are
discussed in the second chapter. Highly accurate indications are extremely important
in future treatment decisions. Abnormal left ventricular response to exercise and
change in the hemodynamic severity of the valvular disease add to the prognostic
value of clinical symptoms. Therefore stress testing is debated in the third chapter.
Successful valve replacement surgery in elderly and often polymorbid patients with
congestive heart failure would not be possible without properly aimed modern
anesthesia and monitoring. Patients formerly considered inoperable are now profiting
from valve replacement procedures. Challenges in anesthesia and post-surgical care
are described in chapter four. The only mode of treatment of highly calcified
degenerated native aortic valve is its replacement. In chapter five types of surgical
approaches and valve prostheses are discussed.
Currently, there is no artificial aortic valve prosthesis hemodynamically equal to
native healthy aortic valve. The condition, where the prosthesis orifice is distinctly
smaller for a given patient than natively appropriate is defined as patient-prosthesis
VIII Preface
mismatch. Clinical importance of this phenomenon is the subject of chapter six. Atrial
fibrillation is the most common concurrent arrhythmia associated with heart valve
diseases and is very poorly tolerated by patients. Sinus rhythm restitution contributes
to hemodynamic heart output increase and clinical status improvement. Atrial
fibrillation treatment modalities are debated in chapter seven. Despite increasing
safeness of standard aortic valve replacement surgery, it is still greatly complex
procedure connected with possible adverse complications especially in polymorbid
elderly patients. Therefore an effort to decrease extensiveness of surgery has led to
development of mini-invasive approaches and procedures. These principles and
techniques, which are still evolving, are discussed in the final chapter.
Limited volume of this book cannot substitute comprehensiveness of textbooks, but
tries to depict current advances in aortic valve stenosis evaluation and treatment.
Petr Šantavý, M.D., Ph.D.
Dept. of Cardiac Surgery, Palacky Universtity Teaching Hospital, Olomouc,
Czech Republic
