• Clinical science

Aortic valve stenosis


Aortic stenosis (AS) is a valvular heart disease characterized by narrowing of the aortic valve. As a result, the outflow of blood from the left ventricle into the aorta is obstructed. This leads to chronic and progressive excess load on the left ventricle and potentially left ventricular failure. The patient may remain asymptomatic for long periods of time; for this reason, AS is often detected late, i.e., when it first becomes symptomatic (dyspnea on exertion, angina pectoris, or syncope). Auscultation reveals a harsh, crescendo-decrescendo murmur in systole that radiates to the carotids, and pulses are delayed with diminished carotid upstrokes. Echocardiography is the gold standard for diagnosis. Patients with asymptomatic aortic stenosis are treated conservatively. Symptomatic patients or those with severe aortic valve stenosis require valve replacement.


  • Most common valvular heart disease in industrialized countries
  • Prevalence:
    • Increases with age
    • May reach up to 12.4% among individuals ≥ 75 years


Epidemiological data refers to the US, unless otherwise specified.


By location of obstruction

  • Valvular: most common
  • Supravalvular
  • Subvalvular

By etiology

  • Congenital:
    • Bicuspid aortic valve: caused by a fusion of two of the three aortic-valve leaflets in utero
      • Most common congenital heart defect, 3:1 predominance
      • Predisposes the valve to dystrophic calcification and degeneration
      • Patients present with symptoms of aortic stenosis earlier than in regular aortic valve calcification
  • Acquired
    • Calcific aortic stenosis: most common cause of aortic stenosis
    • Rheumatic fever is a rare cause of AS in developed countries, but continues to remain a significant cause in developing countries.




Clinical features

SAD (syncope, angina, dyspnea)

Without definite treatment (surgery), more than 50% of the symptomatic patients with severe aortic stenosis will die within the first 2 years of diagnosis!





  • Conservative management: regular follow-ups indicated for asymptomatic patients with mild aortic stenosis
  • Surgical (see heart valve prostheses)
    • Indications
      • Symptomatic patients
      • Asymptomatic patients with severe AS and either significantly ↓ LV EF or those undergoing cardiac surgery
    • Aortic valve replacement (AVR): 3 possible approaches
      • Surgical AVR: patients with low surgical risk.
      • Transcatheter AVR (TAVR): patients with high surgical risk or contraindication
      • Catheter balloon valvuloplasty: children without AV calcification

The presence of exertional symptoms (dyspnea on exertion, angina pectoris, syncope) is an indication for surgery!


  • Asymptomatic patients: The mortality rate is < 1% in a given year.
  • Symptomatic patients: The mortality rate in the first 2 years is > 50%.


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last updated 12/11/2019
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