Left Ventricular Fibrosis in Patients with Aortic Stenosis
Aortic valve stenosis is the commonest form of valvular heart disease in the Western world, currently affecting about 7% of the population over the age of 60, while 3% of people over the age of 75 have severe stenosis. With an aging population, its preval
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Left Ventricular Fibrosis in Patients with Aortic Stenosis Vassilis S. Vassiliou, Calvin W. L. Chin, Tamir Malley, David E. Newby, Marc R. Dweck, and Sanjay K. Prasad
8.1
Introduction
Aortic valve stenosis (AS) is the commonest form of valvular heart disease in the Western world, currently affecting about 7% of the population over the age of 60, while 3% of people over the age of 75 have severe AS [1]. This is a disease associated with advanced age, and its prevalence
V. S. Vassiliou (*) · S. K.Prasad Department of Cardiology and NIHR Biomedical Research Unit, Royal Brompton Hospital, London, UK National Heart and Lung Institute, Imperial College London, London, UK e-mail: [email protected]; [email protected] C. W. L. Chin British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK Department of Cardiovascular Medicine, National Heart Center Singapore, Singapore, Singapore e-mail: [email protected] T. Malley Department of Cardiology and NIHR Biomedical Research Unit, Royal Brompton Hospital, London, UK e-mail: [email protected] D. E. Newby · M. R. Dweck British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK e-mail: [email protected]; [email protected]
is expected to increase dramatically in the next few decades alongside an aging population [2]. Without any treatment, AS leads to a high- pressure load on the left ventricle (LV), an abnormal process leading to myocyte hypertrophy and increases in LV wall thickness and mass. Normal wall stress and contraction are initially maintained in the hypertrophied ventricle in accordance to Laplace law, keeping normal contractility and cardiac output [3]. However, the process, usually over a period of months or years, becomes maladaptive with further myocyte hypertrophy, myocardial fibrosis, and myocyte death resulting in increased ventricular stiffness, reduced systolic function, and increase in patient morbidity and mortality [4]. At present there is no medical therapy that can reverse or alter the course of progression of aortic stenosis, and the only therapeutic option for patients with severe symptomatic AS is surgical or percutaneous aortic valve replacement conferring significant morbidity, mortality, and expense [5].
8.2
urrent Clinical Challenges C Associated with Aortic Stenosis
A crucial aspect of the management of AS patients relates to the optimal timing of intervention, either with surgical valve replacement (AVR) or percutaneous valve implantation
© Springer-Verlag GmbH Austria, part of Springer Nature 2019 O. H. Stanger et al. (eds.), Surgical Management of Aortic Pathology, https://doi.org/10.1007/978-3-7091-4874-7_8
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(TAVI). Operate too early, and patients may be exposed unnecessarily to the risks associated with surgery and related to prosthetic valve (e.g., infection, bleeding related to anticoagulation, and valve degeneration). Operate too late, and patients will susta
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