Chaliki Hari P, Brown Morgan L, Sundt Thoralf M, Tajik A Jamil
Mayo Clinic Arizona, Division of Cardiovascular Diseases, 13400 E. Shea Boulevard, Scottsdale, AZ 85255, USA.
Expert Rev Cardiovasc Ther. 2007 Nov;5(6):1065-71. doi: 10.1586/14779072.5.6.1065.
Calcific aortic stenosis is now the main cause of aortic stenosis in the majority of patients, due to declining incidence of rheumatic fever. Risk factors such as hyperlipidemia play an important role in the progression of aortic stenosis. According to the most recent American College of Cardiology/American Heart Association guidelines, peak velocity greater than 4 m/sec, a mean gradient of more than 40 mmHg and a valve area of less than 1.0 cm(2) is considered hemodynamically severe aortic stenosis. Aortic valve surgery promptly should be done in symptomatic patients due to dismal prognosis without operation. Features such as high aortic valve calcium and positive exercise test identify asymptomatic patients who would benefit from early aortic valve surgery. Due to improvement in surgical techniques and better prosthesis, aortic valve surgery can now be offered at low risk to a selected group of asymptomatic patients with severe aortic stenosis. Currently percutaneous aortic valves are used in very high-risk patients with severe symptomatic aortic stenosis. Their role may expand in the future, depending on the improvements in design and operator experience. Whether advances in molecular cardiology lead to novel therapies in preventing calcific aortic stenosis in the future remains to be seen.
由于风湿热发病率下降，钙化性主动脉瓣狭窄现已成为大多数患者主动脉瓣狭窄的主要原因。高脂血症等危险因素在主动脉瓣狭窄的进展中起重要作用。根据美国心脏病学会/美国心脏协会的最新指南，峰值速度大于4米/秒、平均压差大于40毫米汞柱且瓣膜面积小于1.0平方厘米被认为是血流动力学严重的主动脉瓣狭窄。对于有症状的患者，由于不进行手术预后不佳，应及时进行主动脉瓣手术。高主动脉瓣钙化和运动试验阳性等特征可识别出能从早期主动脉瓣手术中获益的无症状患者。由于手术技术的改进和更好的人工瓣膜，现在可以以低风险为一组选定的严重主动脉瓣狭窄无症状患者提供主动脉瓣手术。目前，经皮主动脉瓣用于患有严重症状性主动脉瓣狭窄的极高风险患者。其作用未来可能会扩大，这取决于设计的改进和操作者的经验。分子心脏病学的进展未来是否会带来预防钙化性主动脉瓣狭窄的新疗法仍有待观察。
