Clinical Review

Degenerative aortic stenosis

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39478.498819.AD (Published 06 March 2008) Cite this as: BMJ 2008;336:550
  1. Radhakrishnan Ramaraj, resident physician1,
  2. Vincent L Sorrell, professor of clinical medicine and radiology, and Allan C Hudson and Helen Lovaas chair of cardiac imaging2
  1. 1Department of Internal Medicine, Section of Cardiology, Sarver Heart Center, University of Arizona College of Medicine, 1501, N Campbell Avenue, Tucson, AZ 85724, USA
  2. 2Section of Cardiology, Sarver Heart Center, University of Arizona College of Medicine
  1. Correspondence to: R Ramaraj drkutty2{at}gmail.com
  • Accepted 25 January 2008

Summary points

  • Although aortic stenosis is common, its diagnosis may be missed

  • Calcific aortic stenosis shares many common features with atherosclerosis

  • After the onset of symptoms, the average survival is two to three years, and patients with symptoms of syncope, angina, and dyspnoea need prompt aortic valve replacement

  • Endocarditis prophylaxis is indicated in all patients with aortic stenosis

  • Echocardiography should be performed once aortic stenosis is suspected.

  • Coronary artery angiography is usually needed before aortic valve replacement, except in young patients

  • Careful exercise testing should be considered in asymptomatic patients with severe aortic stenosis who are sedentary or unable to give a clear history

Aortic stenosis is the most common valvular lesion in Europe and North America. It primarily presents as calcific aortic stenosis in 2-7% of the population aged >65 years.1 About 80% of adult patients with symptomatic aortic stenosis are male. As 1-2% of the population is born with a congenital bicuspid aortic valve and populations are ageing, aortic stenosis is becoming more common. By 2020, about 3.5 million people in England are expected to have aortic sclerosis and 150 000 will have severe aortic stenosis.2 Here we provide an overview to help diagnosis and a summary of the management of AS and its sequelae. Many of the points made in this review are based on randomised controlled trials. However, observational studies and the guideline recommendations of the American Heart Association and the American College of Cardiology and of the European Society of Cardiology are also included to provide comprehensive overviews that are beyond the scope of this article.

What are the factors leading to aortic stenosis?

The most common cause of aortic stenosis in adults is calcification of a normal trileaflet (fig 1). Calcific aortic stenosis is thought to be a degenerative process that shares many features with coronary artery disease, such as lipid accumulation, …

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