Marcelo Katz

Severe aortic stenosis in asymptomatic patients: the dilemma of clinical versus surgical treatment

La estenosis valvular aortica es cada vez mas prevalente concordante con el envejecimiento poblacional. Por consiguiente, se vuelve mas comun la atencion de pacientes asintomaticos con estenosis aortica grave. Aunque los pacientes con estenosis aortica grave sin sintomas hagan parte de un mismo grupo, son heterogeneos bajo el punto de vista clinico, de laboratorio y ecocardiografico. El abordaje de esos pacientes trae a cuento el dilema del tratamiento clinico versus quirurgico: someter el paciente a los riesgos de la cirugia o mantenerlo en observacion clinica bajo el peligro de dano miocardico irreversible o aun de muerte subita? Bajo esta perspectiva, basandose en la literatura actual, este articulo provee herramientas que auxilian en la estratificacion de los pacientes. El area valvar, grado de calcificacion, velocidad de flujo transvalvar aortico, hipertrofia ventricular izquierda y test de esfuerzo alterado son los factores que colocan a los portadores de estenosis aortica grave asintomaticos en un grupo denominado de muy alto riesgo, en que la estrategia quirurgica pasa a ser considerada.Aortic valve stenosis has become increasingly prevalent, in agreement with the aging of the population. Thus, it has become increasingly common to treat asymptomatic patients with severe aortic stenosis. Although the patients with asymptomatic aortic stenosis belong to the same group, they are heterogeneous from a clinical, laboratory and echocardiographic point of view. The treatment of these patients raises the dilemma of the clinical versus the surgical treatment: should we submit the patient to the risks of surgery or keep the patient under clinical observation, running the risk of irreversible myocardial damage or even sudden death? Under this perspective and based on the current literature, this study supplies tools that help to stratify the patients. The valvular area, degree of calcification, transvalvular aortic flow velocity, left ventricular hypertrophy and stress test alterations are the factors that place asymptomatic individuals with severe aortic stenosis in a group called very-high risk, in which the surgical approach starts to be considered.

Estenose aórtica grave em pacientes assintomáticos: o dilema do tratamento clínico versus cirúrgico

La estenosis valvular aortica es cada vez mas prevalente concordante con el envejecimiento poblacional. Por consiguiente, se vuelve mas comun la atencion de pacientes asintomaticos con estenosis aortica grave. Aunque los pacientes con estenosis aortica grave sin sintomas hagan parte de un mismo grupo, son heterogeneos bajo el punto de vista clinico, de laboratorio y ecocardiografico. El abordaje de esos pacientes trae a cuento el dilema del tratamiento clinico versus quirurgico: someter el paciente a los riesgos de la cirugia o mantenerlo en observacion clinica bajo el peligro de dano miocardico irreversible o aun de muerte subita? Bajo esta perspectiva, basandose en la literatura actual, este articulo provee herramientas que auxilian en la estratificacion de los pacientes. El area valvar, grado de calcificacion, velocidad de flujo transvalvar aortico, hipertrofia ventricular izquierda y test de esfuerzo alterado son los factores que colocan a los portadores de estenosis aortica grave asintomaticos en un grupo denominado de muy alto riesgo, en que la estrategia quirurgica pasa a ser considerada.Aortic valve stenosis has become increasingly prevalent, in agreement with the aging of the population. Thus, it has become increasingly common to treat asymptomatic patients with severe aortic stenosis. Although the patients with asymptomatic aortic stenosis belong to the same group, they are heterogeneous from a clinical, laboratory and echocardiographic point of view. The treatment of these patients raises the dilemma of the clinical versus the surgical treatment: should we submit the patient to the risks of surgery or keep the patient under clinical observation, running the risk of irreversible myocardial damage or even sudden death? Under this perspective and based on the current literature, this study supplies tools that help to stratify the patients. The valvular area, degree of calcification, transvalvular aortic flow velocity, left ventricular hypertrophy and stress test alterations are the factors that place asymptomatic individuals with severe aortic stenosis in a group called very-high risk, in which the surgical approach starts to be considered.

Topographic Pattern of Valve Calcification: A New Determinant of Disease Severity in Aortic Valve Stenosis

The pathophysiology of degenerative aortic valve stenosis (AS) is intimately related to the development of calcific deposits in the valve structure. Multidetector computed tomography (MDCT), a reliable method to delineate the tridimensional heart geometry, has been shown to accurately quantify the

Estenosis aórtica grave en pacientes asintomáticos: el dilema del tratamiento clínico versus quirúrgico

La estenosis valvular aortica es cada vez mas prevalente concordante con el envejecimiento poblacional. Por consiguiente, se vuelve mas comun la atencion de pacientes asintomaticos con estenosis aortica grave. Aunque los pacientes con estenosis aortica grave sin sintomas hagan parte de un mismo grupo, son heterogeneos bajo el punto de vista clinico, de laboratorio y ecocardiografico. El abordaje de esos pacientes trae a cuento el dilema del tratamiento clinico versus quirurgico: someter el paciente a los riesgos de la cirugia o mantenerlo en observacion clinica bajo el peligro de dano miocardico irreversible o aun de muerte subita? Bajo esta perspectiva, basandose en la literatura actual, este articulo provee herramientas que auxilian en la estratificacion de los pacientes. El area valvar, grado de calcificacion, velocidad de flujo transvalvar aortico, hipertrofia ventricular izquierda y test de esfuerzo alterado son los factores que colocan a los portadores de estenosis aortica grave asintomaticos en un grupo denominado de muy alto riesgo, en que la estrategia quirurgica pasa a ser considerada.Aortic valve stenosis has become increasingly prevalent, in agreement with the aging of the population. Thus, it has become increasingly common to treat asymptomatic patients with severe aortic stenosis. Although the patients with asymptomatic aortic stenosis belong to the same group, they are heterogeneous from a clinical, laboratory and echocardiographic point of view. The treatment of these patients raises the dilemma of the clinical versus the surgical treatment: should we submit the patient to the risks of surgery or keep the patient under clinical observation, running the risk of irreversible myocardial damage or even sudden death? Under this perspective and based on the current literature, this study supplies tools that help to stratify the patients. The valvular area, degree of calcification, transvalvular aortic flow velocity, left ventricular hypertrophy and stress test alterations are the factors that place asymptomatic individuals with severe aortic stenosis in a group called very-high risk, in which the surgical approach starts to be considered.