EFFECT OF AORTIC-VALVE REPLACEMENT ON SYNCOPE IN PATIENTS WITH AORTIC-STENOSIS

Objective-To determine the role of exertion as a precipitating factor in syncope in patients with aortic stenosis. Design,-Follow up for at least one year after aortic valve replacement. Setting-Regional cardia c centre. Patients-Consecutive patients who underwent aortic valve rep lacement for aortic stenosis and who had a history of syncope and no o ther clinically significant cardiac lesion were recruited during a fiv e year period. Methods-Patients were interviewed to determine the char acteristics of syncope and were divided into those in whom syncope was consistently related to exertion (group 1, 26 patients) and those in whom it was not (group 2, 13 patients). Recurrence of syncope after va lve replacement was determined at visits to the clinic. Results-Groups 1 and 2 did not differ significantly with respect to valve area, age, or sex. In 13 of the 26 patients in group 1 syncope was preceded by a ngina despite the absence of coronary artery disease, but none of the 13 patients in group 2 had angina. After valve replacement none of gro up 1 and eight of the 13 patients in group 2 had recurrence of syncope (p < 0.01). Conclusion-When patients with aortic stenosis experience syncope unrelated to exertion, the symptom is usually unrelated to the valve disease and another cause should be sought.