Curriculum · Cardiovascular and Hypertension
Transcatheter aortic valve replacement
What it is
Transcatheter therapy means that there are now prosthetic aortic valves that can be delivered by transcatheter systems. These have been approved for patients with critical AS who are otherwise not candidates for surgery, and survival is improved compared to medical therapy.
Causes and risk
Aortic stenosis has three causes. The most common is calcification and degeneration of a congenitally normal valve, in the old patient. Next is calcification and fibrosis of a congenitally bicuspid aortic valve. Third is rheumatic valvular disease, and if the aortic valve is affected by rheumatic fever the mitral valve is also invariably affected. A bicuspid aortic valve is the most common congenital cardiac anomaly, 1 in 50, and by age 45 half will have significant AS.
How it presents
Severe symptomatic aortic stenosis gives shortness of breath with activity. A 68-year-old female with a history of a bicuspid aortic valve and aortic stenosis used to walk 2 miles daily for exercise but can no longer do so because of dyspnea and chest tightness, and she also reports mild lower extremity edema.