Lesbre J P, Peltier M
Service de Cardiologie, CHU d'Amiens, Hôpital Sud, Amiens.
Ann Cardiol Angeiol (Paris). 1995 Jan;44(1):41-5.
Ostial aortic stenosis is clearly the commonest form of valvular heart disease in adults at the present time, as it represents 26% of all forms of valvular heart disease and 2% of all forms of heart disease. It is a disease middle and old-age, which appears to becoming increasingly frequent due to ageing of the population. It affects men twice as often as women and sometimes has a misleading clinical presentation at the stage of heart failure due to disappearance of the usual systolic murmur. The patient may simply present with signs of refractory left ventricular failure or complete heart failure. The diagnosis and follow-up have been radically transformed by the development of Doppler ultrasonography which allows the positive diagnosis as well as a very precise assessment of the severity, avoiding the need for cardiac catheterization, but unfortunately coronary angiography still remains essential in view of the age of these patients. In terms of treatment, percutaneous valvuloplasty according to the method developed by Cribier has unfortunately not lived up to expectations and tight aortic stenosis remains a surgical disease whose results are among the most spectacular: the patient's dramatic functional and objective transformation following insertion of a valvular prosthesis (mechanical before the age of 75 years, bioprosthesis after this age), at the cost of a reasonable operative mortality of approximately 5 to 8% in the 71 to 80 year age-group, must be stressed.
目前，主动脉瓣狭窄显然是成人心脏瓣膜病最常见的形式，占所有心脏瓣膜病形式的26%，占所有心脏病形式的2%。这是一种中老年疾病，由于人口老龄化，其发病率似乎越来越高。男性受影响的频率是女性的两倍，在心力衰竭阶段，由于通常的收缩期杂音消失，有时会有误导性的临床表现。患者可能仅表现为难治性左心室衰竭或完全心力衰竭的体征。多普勒超声心动图的发展彻底改变了诊断和随访方式，它可以做出肯定诊断并对严重程度进行非常精确的评估，避免了心脏导管检查的需要，但不幸的是，鉴于这些患者的年龄，冠状动脉造影仍然必不可少。在治疗方面，遗憾的是，按照克里比埃开发的方法进行的经皮瓣膜成形术并未达到预期效果，重度主动脉瓣狭窄仍然是一种需要手术治疗的疾病，其治疗效果非常显著：植入瓣膜假体（75岁之前使用机械瓣膜，75岁之后使用生物瓣膜）后，患者的功能和客观状况会发生巨大转变，必须强调的是，在71至80岁年龄组中，手术死亡率约为5%至8%，这是一个合理的代价。
