Is it possible to assess progression of valvular aortic stenosis?

Background and objective It is of great importance to assess progression of aortic valvar stenosis (AVS) when cardiac surgery is planned for other ind ications when established criteria for aortic valve replacement are not ful filled at that moment. These considerations have often been ignored in pros pective planning of treatment, necessitaring a second cardiac surgical inte rvention just a few years later. The aim of this study was to establish cri teria for estimating the rate of progression of AVS. Patients and methods: Clinical, echocardiographic and haemodynamic data wer e analysed for 169 patients with aortic valvar stenosis 169 men, 88 women; mean age at first cardiac catheterization [CC] 55.2 +/- 15.7 years, at seco nd CC 63.4 +/- 15.6 years. Results: The degree of AVS increases exponentially in relation to the exten t of calcification (graded 0-3) and the fall in transaortic gradient (TG), from a TG > 0.6 mmHg/ml stroke volume and can be sufficiently predictable f or clinical purposes. But neither age, sex nor the aetiology/pathology of t he valvar defect have a sustained influence on the progression of AVS. Conclusions: These data indicate that knowing the current reduction in TG a nd the degree of calcification makes it possible to assess the likely progr ession of previously asymptomatic AVS and thus greatly facilitate the decis ion of whether or not to combine aortic valve replacement with another indi cated cardiac operation.