Therapy of aortic valve stenosis [Therapie der Aortenklappenstenose]

Calcific aortic stenosis is the most frequent valve disorder in the western world. It is a degenerative and chronic progressive disease in the elderly with increasing prevalence due to the demographic development in the population. As there is no medical therapy, the only option in severe aortic stenosis is valve replacement. Echocardiography is the diagnostic tool to assess aortic stenosis severity and morphology of the valve. Aortic stenosis is severe if the valve area is < 1.0 cm2, valve index < 0.6 cm2/m2 body surface, mean gradient > 40 mmHg, and peak velocity > 4.0 m/s. The entity of low flow, low gradient aortic stenosis is complex, and diagnosis and therapy are still challenging. Asymptomatic patients have a good prognosis, but must be reevaluated on a regular basis for the onset of symptoms or signs of progression. If one of the classical symptoms dyspnea and fatigue, angina pectoris or syncope occurs prognosis worsens dramatically and valve replacement is indicated. Gold standard therapy for aortic stenosis is surgical valve replacement. For high-risk patients (older age and severe comorbidities), transcatheter aortic valve implantation (TAVI) is established as standard therapy. © 2014, Springer-Verlag Berlin Heidelberg.