Asymptomatic Valvular Heart Disease: Indications and Timing for Surgery

Abstract

Patients who have severe aortic stenosis and remain asymptomatic is an issue of great interest and controversy. The reason of the argument is that on one side many physicians believe that irreversible myocardial damage and fibrosis may develop during a prolonged asymptomatic stage and therefore delayed aortic valve replacement will not have ideal results [1]. On the other side early surgery is associated with perioperative mortality and morbidity and significant long-term morbidity (2%/year) and mortality (1%/year), which combined together, exceed the possibility of sudden death (1%/year) from the aortic stenosis itself [2,3]. Therefore we should try to identify patients who may be at high risk of sudden death or patients who are ???pseudo-asymptomatic?? by limiting their gradual daily physical activity. Exercise stress test within a hospital environment is a useful tool to reveal these groups of patients.In brief, asymptomatic patients with severe aortic stenosis who have abnormal stress test or left ventricular systolic dysfunction or excessive left ventricular hypertrophy or very tight aortic stenosis, should be offered the benefit of aortic valve replacement.