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from Section 3.1 - Cardiac and Circulatory Failure
Published online by Cambridge University Press: 27 July 2023
Key Learning Points
1. The most common cause of aortic stenosis (AS) in patients aged <70 years is bicuspid aortic valve; aortic sclerosis is the most common precursor in the elderly. Surgical valve replacement is the best option for many patients, but transcatheter replacement is now available for patients at high and intermediate surgical risk.
2. The primary causes of acute aortic regurgitation (AR) are infective endocarditis and dissection of the ascending aorta; chronic AR in adults is most often caused by degeneration of the aortic valve or root. Acute AR requires prompt aortic valve replacement or repair.
3. Chronic AR requires aortic valve replacement or repair when symptoms or left ventricular (LV) dysfunction develops.
4. Common causes of mitral regurgitation (MR) include mitral valve prolapse, rheumatic fever and LV dilation or infarction. Valve repair is the preferred treatment to valve replacement in symptomatic patients.
5. Mitral stenosis is almost always caused by rheumatic fever. Pulmonary hypertension and atrial fibrillation may develop. Severely symptomatic patients and those with evidence of pulmonary hypertension require commissurotomy or valve replacement.
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