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Practical echocardiography in aortic valve stenosis

Nistri, Stefano; Galderisi, Maurizio; Faggiano, Pompilio; Antonini-Canterin, Francesco; Ansalone, Gerardo; Dini, Frank Lloyd; Di Salvo, Giovanni; Gallina, Sabina; Mele, Donato; Montisci, Roberta; Sciomer, Susanna; Di Bello, Vitantonio; Mondillo, Sergio; Marino, Paolo Nicolaon behalf of the Working Group on Echocardiography of the Italian Society of Cardiology

Journal of Cardiovascular Medicine: July 2008 - Volume 9 - Issue 7 - p 653–665
doi: 10.2459/JCM.0b013e3282f27d49
Review articles

Aortic valve stenosis is a common disease. Despite this, the diagnosis may often be missed; a significant proportion of patients are still identified at post-mortem examination, and 5% of operations are performed at end stage. Unrecognized aortic valve stenosis is an important cause of anesthetic mortality. One reason for failing to make a diagnosis is that the clinical signs can be difficult to interpret due to the confounding association with arterial hypertension, coronary artery disease and systemic arteriosclerosis, potentially blunting the effects of aortic valve stenosis on the circulation. Moreover, most patients with aortic valve stenosis have a long asymptomatic period and may not seek medical attention. In patients with severe, symptomatic, calcific aortic valve stenosis, aortic valve replacement is the only effective treatment; much evidence suggests that it should be offered to patients regardless of age, after appropriate clinical evaluation.

Doppler echocardiography plays a pivotal role in confirming the diagnosis of aortic valve stenosis in assessing the severity of the disease and, ultimately, in giving prognostically relevant information. Moreover, echocardiography is suitable for monitoring of disease progression and left ventricular function in these patients, and is of fundamental support for clinical follow-up. Accurate noninvasive quantification of aortic valve stenosis is, however, a technically demanding and time-consuming procedure, with several potential pitfalls. Considering the frequency and importance of aortic valve stenosis, a comprehensive echocardiographic study should be offered and carefully performed in all patients with noteworthy murmurs and repeated regularly (at appropriate time intervals), together with clinical review, in patients in whom aortic valve stenosis has been diagnosed.

aCardiology Service, CMSR Veneto Medica, Altavilla Vicentina (VI), Italy

bDepartment of Clinical and Experimental Medicine, Federico II University Hospital of Naples, Italy

cDepartment of Cardiology, Spedali Civili e Cattedra di Cardiologia, University of Brescia, Italy

dCardiology, ARC, S. Maria degli Angeli Hospital, Pordenone, Italy

eDepartment of Cardiology, Ospedale Madre Giuseppina Vannini, Roma, Italy

fUnità Malattie Cardiovascolari 2, Santa Chiara Hospital, Pisa, Italy

gDepartment of Pediatric Cardiology, Second University of Naples, Monaldi Hospital, Italy

hDepartment of Cardiology, San Camillo Hospital, University of Chieti, Italy

iDepartment of Cardiology, Azienda Ospedaliera Universitaria, Ferrara, Italy

jDepartment of Cardiovascular and Neurological Sciences, University of Cagliari, Italy

kDepartment of Cardiology, University of Rome “La Sapienza”, Italy

lCardiac Thoracic and Vascular Department, University of Pisa, Italy

mDepartment of Cardiology, University of Siena, Italy

nDepartment of Cardiology, “Maggiore della Carita” Hospital, Eastern Piedmont University, Italy

Received 12 May, 2007

Revised 19 July, 2007

Accepted 21 September, 2007

Correspondence to Stefano Nistri, MD, Servizio di Cardiologia, CMSR Veneto Medica, Via Vicenza, 204, 360777 Altavilla Vicentina (VI), Italy Tel: +39 0444 225111; fax: +39 0444 225199; e-mail: snistr@tin.it

© 2008 Italian Federation of Cardiology. All rights reserved.