Is common, but often unrecognised

Aortic valve disease is common. In Western populations, about 25% of people aged over 65 have aortic sclerosis, and 3% over 75 have severe stenosis.1 In 2003, 6028 aortic valve operations were done in Britain and Ireland compared with 25 277 for isolated coronary disease.2 Despite this the diagnosis may often be missed. Probably half are still diagnosed at postmortem examination, and 5% of operations are performed at end stage.3 Unrecognised aortic stenosis is an important cause of anaesthetic and obstetric mortality.

The overwhelming cause of aortic valve disease in Europe is calcific degenerative disease, and about 2% of the population have congenitally bicuspid aortic valves. Rheumatic disease is now rare. Stenosis is differentiated from sclerosis, when a restriction of cusp movement and a raised transaortic peak velocity are seen on echocardiography. Around 16% of patients with sclerosis progress to stenosis in seven years.4 The early lesions of …