Drobinski G, Montalescot G
Service de Cardiologie, CHU Pitié-Salpêtrière, Paris.
Ann Cardiol Angeiol (Paris). 1994 Nov;43(9):519-22.
Aortic stenosis is a condition in which progression accelerates with the onset of warning symptoms such as angina pectoris, syncope and heart failure. Surgery must be scheduled as quickly as possible in all such symptomatic patients, even in the presence of concomitant coronary disease, or of left ventricular failure. Aortic valve surgery is possible in the elderly, with a higher operative risk, but with the benefit of a symptomatic improvement identical to that seen in younger individuals, and a prolongation of life expectancy. Surgery is often considered in asymptomatic patients because of the fear of sudden death. In actual fact, sudden death not preceded by other symptoms is rare and the aim of surveillance must be to identify high-risk patients to whom surgery may be offered: poor exercise tolerance in a cautiously administered exercise test, abnormal ventricular function by echocardiography, or the existence of arrhythmias, which are also a severity factor, whether atrial or ventricular. The number of completely asymptomatic cases among patients with tight aortic stenosis is relatively slight, having been evaluated at 5%. It is in these asymptomatic patients, when they are young, that it is possible to delay surgery until the onset of a first symptom.
主动脉瓣狭窄是一种随着心绞痛、晕厥和心力衰竭等警示症状的出现而病情加速进展的病症。对于所有此类有症状的患者，即使存在合并冠状动脉疾病或左心室衰竭，也必须尽快安排手术。老年患者也可行主动脉瓣手术，虽然手术风险较高，但症状改善情况与年轻患者相同，且能延长预期寿命。由于担心猝死，无症状患者也常考虑手术。实际上，无其他症状先兆的猝死很少见，监测的目的必须是识别出可考虑手术的高危患者：在谨慎进行的运动试验中运动耐量差、超声心动图显示心室功能异常，或存在心律失常（这也是一个严重程度因素，无论是房性还是室性）。主动脉瓣狭窄严重的患者中完全无症状病例的数量相对较少，据评估为5%。正是在这些年轻的无症状患者中，可以将手术推迟到首次出现症状时进行。
