A RAPIDLY GROWING VALVULAR HEART-DISEASE - DEGENERATIVE AORTIC-STENOSIS - DIAGNOSTIC AND THERAPEUTIC ELEMENTS

Ostial aortic stenosis is clearly the commonest form of valvular heart disease in adults at the present time, as it represents 26% of all fo rms of valvular heart disease and 2% of all forms of heart disease. It is a disease middle and old-age, which appears to becoming increasing ly frequent due to ageing of the population. It affects men twice as o ften as women and sometimes has a misleading clinical presentation at the stage of heart failure due to disappearance of the usual systolic murmur. The patient may simply present with signs of refractory left v entricular failure or complete heart failure. The diagnosis and follow -up have been radically transformed by the development of Doppler ultr asonography which allows the positive diagnosis as well as a very prec ise assessment of the severity, avoiding the need for cardiac catheter ization, but unfortunately coronary angiography still remains essentia l in view of the age of these patients. In terms of treatment, percuta neous valvuloplasty according to the method developed by Cribier has u nfortunately not lived up to expectations and tight aortic stenosis re mains a surgical disease whose results are among the most spectacular: the patient's dramatic functional and objective transformation follow ing insertion of a valvular prosthesis (mechanical before the age of 7 5 years, bioprosthesis after this age), at the cost of a reasonable op erative mortality of approximately 5 to 8% in the 71 to 80 year age-gr oup, must be stressed.