Diagnosis and therapy of aortic stenosis in older age. When does it become critical

Together with mitral valve insufficiency, aortic stenosis is the most common heart defect in adulthood. The two major forms are degenerative senile aortic stenosis of old age, and secondary degenerated bicuspid valve manifesting in middle age. A typical feature is a lengthy asymptomatic course due to compensating ventricular hypertrophy with a constant systolic wall tension. With the aid of Doppler echocardiography aortic stenosis can be accurately quantified. Although effective drug treatment is not available, evidence is mounting that statins are capable of slowing the progression of valvular sclerosis, presumably on the basis of pleiotropic, anti-inflammatory effects. As a rule, the onset of symptoms (dyspnea, angina, syncope) is an indication for surgery. As a result of rising life expectancy, the proportion of elderly and very old patients with degenerative senile aortic stenosis is increasing appreciably, and presents a challenge in terms of deciding appropriate individual therapy. Advances in valvular surgery in high old age, however, can offer many of these patients the option of a procedure with an acceptably low risk and longer-term prognostic and symptomatic benefits following successful surgery.