Aortic stenosis causes

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Aortic Stenosis Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aortic Stenosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Cardiac Stress Test

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography

Cardiac Catheterization

Aortic Valve Area

Aortic Valve Area Calculation

Treatment

General Approach

Medical Therapy

Surgery

Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty

Transcatheter Aortic Valve Replacement (TAVR)

TAVR vs SAVR
Critical Pathway
Patient Selection
Imaging
Evaluation
Valve Types
TAVR Procedure
Post TAVR management
AHA/ACC Guideline Recommendations

Follow Up

Prevention

Precautions and Prophylaxis

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Mohammed A. Sbeih, M.D. [2]; Lakshmi Gopalakrishnan, M.B.B.S. [3] Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]

Overview

The frequency of causes of aortic stenosis varies depending on the age of the patient. Bicuspid valve is the most common cause of aortic stenosis in people below 50 years of age whereas calcified tricuspid valve is more common in older patients.

Causes

Valvular Aortic Stenosis

Subvalvular Aortic Stenosis

Supravalvular Aortic Stenosis

  • Hypoplasia of aorta
  • Hourglass constriction of aorta
  • Fibromembranous aortic lesion

Frequency of Underlying Causes of Aortic Stenosis

According to the Euro Heart Survey[1] on valvular heart disease, the frequencies of the different underlying causes of aortic stenosis were the following:

  1. Calcific degeneration - 81.9%
  2. Rheumatic fever - 11.2% [4].
  3. Congenital - 5.6%
  4. Post-endocarditis - 1.3%

Causes of Aortic Valve Calcification:

  • Aortic stenosis is most commonly caused by age-related progressive calcification of the normal tricuspid aortic valve (>50% of cases).
  • Other causes include:

Causes of More Rapid AS Progression:

  • Normal valves have three leaflets (tricuspid), but some valves have only two (bicuspid). Aortic stenosis due to calcification of a bicuspid valve typically becomes symptomatic in the 40s and 50s whereas that due to calcification of a normal valve manifests later in the 70s and 80s. Hypertension, diabetes mellitus, hyperlipoproteinemia and uremia may speed up the process [4].

Cause of Aortic Stenosis as a Function of Age

The cause of aortic stenosis will vary with age[5][6]:

  • Under Age 70:
    • Bicuspid aortic valve - 50%
    • Postinflammatory - 25%
    • Degenerative calcific - 18%
    • Unicommissural - 3%
    • Hypoplastic - 2%
    • Indeterminant - 2%
  • Over Age 70:
    • Degenerative calcific - 48%
    • Bicuspid - 27%
    • Postinflammatory - 23%
    • Hypoplastic - 2%

Complete Differential Diagnosis for the Causes of Aortic Stenosis

Organized by Organ System

Cardiovascular Age-induced calcification of normal tricuspid aortic valve 'wear and tear' (around the 7th or 8th decade of life), atherosclerosis (normal tricuspid valve becomes rigid with age, usually stenosis develops over age 70 and it is rarely severe), congenital bicuspid aortic valve (it is twice as common in men, there is slow increase in stenosis -progressive sclerosis- and as individuals age, calcification of the aortic valve may occur and result in stenosis, this occurs in the 40s and 50s in case of bicuspid valve), prosthetic aortic valve, rheumatic fever (slowly progressive stenosis), subacute bacterial endocarditis.
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental Radiation.
Gastroenterologic No underlying causes
Genetic 1/3rd of supravalvular aortic stenosis cases are transmitted as an autosomal dominant trait as 60% of patients with supravalvular obstruction have williams syndrome (supravalvular obstruction, intellectual impairment and facial abnormalities).
Hematologic No underlying causes.
Iatrogenic Radiation treatment to the chest.
Infectious Disease Bacterial endocarditis in which the vegetations may favor increase risk of stenosis.
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic Fabry disease, Homozygous type II hypercholesterolemia, Ochronosis, Paget's disease
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes.
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy rheumatic fever (slowly progressive stenosis).
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetic Order

References

  1. 1.0 1.1 1.2 Cleland JG, Swedberg K, Follath F, Komajda M, Cohen-Solal A, Aguilar JC, Dietz R, Gavazzi A, Hobbs R, Korewicki J, Madeira HC, Moiseyev VS, Preda I, van Gilst WH, Widimsky J, Freemantle N, Eastaugh J, Mason J (2003). "The EuroHeart Failure survey programme-- a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis". European Heart Journal. 24 (5): 442–63. PMID 12633546. Retrieved 2012-04-11. Unknown parameter |month= ignored (help)
  2. Hannoush H, Introne WJ, Chen MY, Lee SJ, O'Brien K, Suwannarat P; et al. (2012). "Aortic stenosis and vascular calcifications in alkaptonuria". Mol Genet Metab. 105 (2): 198–202. doi:10.1016/j.ymgme.2011.10.017. PMC 3276068. PMID 22100375.
  3. Strickberger SA, Schulman SP, Hutchins GM. Association of Paget’s disease of bone with calcific aortic valve disease. Am J Med 1987;82:953-6.
  4. 4.0 4.1 VOC=VITIUM ORGANICUM CORDIS, a compendium of the Department of Cardiology at Uppsala Academic Hospital. By Per Kvidal September 1999, with revision by Erik Björklund May 2008
  5. Roberts WC, Vowels TJ, Ko JM. Comparison of interpretations of valve structure between cardiac surgeon and cardiac pathologist among adults having isolated aortic valve replacement for aortic valve stenosis (+/- aortic regurgitation). Am J Cardiol. Apr 15 2009;103(8):1139-45.
  6. http://emedicine.medscape.com/article/150638-overview#aw2aab6b2b3aa


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