The abnormalities of aortic valve morphology and function represent the most common cardiac-valve lesion particularly in elderly. The etiology of aortic stenosis is degenerative-calcific in the majority of patients. Many risk factors seems to be linked to the calcification and the stenosis of the aortic valve but they must be confirmed. In this review the etiology and the possible physiopathology of the aortic valve stenosis is discussed.
The abnormalities of aortic valve morphology and function represent the most common cardiac-valve lesion, with relevant implications both for medical and surgical treatment. Particularly, the aortic valve sclerosis (aortic valve thickening and calcification without pressure gradient) seem to affect about one fourth of adults over 65 years of age, while the aortic valve stenosis is present in 2├óÔé¼ÔÇ£9% of general population over 65 years of age; an increased prevalence of both sclerosis and stenosis with aging (48% and 4% in those over 85 years) is observed. Furthermore, the number of the aortic valve procedures performed over the last 10 years is increasing if we consider the aortic valve replacement alone or combined with myocardial revascularization; mitral valve surgery seems to be constant in the same period. Also, the etiology of the pathologic process of the aortic valve is changing in the last years. Passik et al. analysed the valve characteristics in 646 patients with pure aortic stenosis who underwent valve replacement between 1981 and 1985 at Mayo Clinic. During the five years of the study, the relative frequency of the postinflammatory disease (i.e. post-rheumatic) decreased from 30% to 18% and the relative frequency of the bicuspid aortic valve changed from 37% to 33%; in contrast, the relative frequency of degenerative-calcific aortic stenosis (an \atherosclerotic\" form of disease, see below) increased from 30% to 46%. These differences were striking in subjects older than 70 years .
Several studies have been published in the last years which clarify the epidemiology of valvular disease and, specifically, of aortic valve disease. In the The EuroHeart Failure survey programme, a survey on the quality of care among patients with heart failure in Europe, of 46.788 patients screened over a six-week period 11.327 (24%) patients were enrolled with a suspected or confirmed heart failure; a valve disease was the cause of heart failure in 29% of the cases, compared with coronary artery disease in 68% and idiopathic dilated cardiomyopathy in 6% . In the Euro-Heart Survey of acute coronary syndromes, 489 out of 10207 (4.8%) patients with acute coronary syndromes enrolled had a significant valve disease. The more common abnormalities were ischemic mitral regurgitation and calcific aortic stenosis. The patients with valve disease were older, more likely females and with comorbidities such as diabetes and chronic renal failure; they more likely have had a prior CHF and LV dysfunction, cardiac ischemic event or revascularization. In-hospital and 30-day mortality of the patients with valve disease were significantly higher than those without (13.4% and 15.5% versus 6.4% and 7.7%, respectively) .
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