Surgery Improves Outcomes in Common but Serious Heart Valve Disease
Newswise — Prompt diagnosis and surgery can be lifesaving for older adults with aortic stenosis, according to an article in a recent issue of Medicine®. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.
Aortic stenosis is a relatively common heart valve disease condition in older adults. Although valve replacement surgery provides good outcomes, the disease can gradually worsen for years before it's recognized. In the new article, renowned expert Dr. Catherine M. Otto of University of Washington, Seattle—along with co-author Dr. Christopher E. Kurtz—presents an up-to-date review of the prevalence and causes, diagnosis, and treatment of aortic stenosis. Shortness of Breath Is Key Early SymptomAortic stenosis refers to narrowing of the aortic valve of the heart, most often caused by buildup of calcium deposits. It can also occur in people who have had rheumatic heart disease. Aortic stenosis occurs mainly in people over 60, rarely in those under 50. It is more common in men than women; other risk factors include high blood pressure and smoking.
As the aortic valve gets narrower, it squeezes off blood flow to the left ventricle of the heart. Over time, patients feel shortness of breath when exercising, which may gradually cause them to reduce their activities. If they seek medical attention at this point, the doctor may hear a heart murmur as the first clue that aortic stenosis is present. If the condition isn't recognized and treated, the aortic valve narrowing will continue to progress—eventually causing symptoms such as angina (chest pain), syncope (fainting), and heart failure.
The standard test for aortic stenosis is echocardiography, which uses ultrasound waves to view the heart in motion. Once the diagnosis is made, the only effective treatment is surgery to replace the diseased valve; medications can't slow the progression of the disease.
"The presence of symptoms due to aortic stenosis indicates urgent valve replacement," Dr. Otto and Kurtz write. They stress that valve replacement should be performed regardless of age or other medical conditions—patients with symptomatic or severe aortic stenosis have "a very tenuous physiology." Valve replacement is sometimes performed at the same time as other cardiac procedures, such as coronary bypass surgery.
With Valve Replacement Surgery, Most Have Good OutcomesThe good news is that, with successful valve replacement surgery, survival approaches that of healthy people of similar age. "When due primarily to aortic stenosis, symptoms resolve in almost all patients," according to the authors. All patients need close follow-up to ensure that the replacement valve is functioning normally.
Of course, the outlook for individual patients depends on a wide range of factors, including age, the severity of disease, and many others. Drs. Otto and Kurtz review a series of patients seen at University of Washington, illustrating the treatment options and outcomes of aortic stenosis in a wide range of common and less-common clinical situations.
The editors of Medicine® have made this important article freely available to all readers at the journal web site, http://www.md-journal.com. "Professor Otto is one of the world's most highly regarded experts in aortic stenosis," comments Dr. Roy C. Ziegelstein, Associate Editor of Medicine. "In this article, along with Dr. Kurtz, she shares the clinical wisdom she has gained from her 25 years of experience treating this condition. The result is a 'classic' in medicine, an article that will be referenced by health care providers for many years to come."
About MedicineMedicine® (http://www.md-journal.com) provides insight from leading scholars about the latest results in clinical investigation. Relevant to both hospital and office practice, the journal includes analytical reviews of Internal Medicine, Dermatology, Neurology, Pediatrics, and Psychiatry topics. Articles typically include original patient data from the author's own experience along with a scholarly review of the literature. Medicine® also offers follow-up studies, practice-oriented reports of clinical observations, and "Reviews in Molecular Medicine," monographs that focus on how genetics and genomics have altered understanding and management of a particular disorder. It is one of the most respected and frequently cited journals in the field.
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