Nouveautés sur le rétrécissement valvulaire aortique

Abstract

Aortic valve stenosis (AS) is the most frequent heart disease after coronary artery disease and arterial hypertension and it is associated with a high incidence of adverse outcomes. Historically, calcific AS has been considered as « degenerative » because it was thought to be the result from aging and « wear and tear » of the aortic valve. However, this perception has changed over the years with the publication of several studies showing that the calcific AS shares many histological similarities with atherosclerosis, thus suggesting that this disease could eventually be modified by lifestyle or pharmacological therapies. Furthermore, recent data support the notion that AS is not an isolated disease uniquely limited to the valve. Indeed, AS is frequently associated with abnormalities of the systemic arterial system, and in particular with reduced arterial compliance, which may have important consequences on the pathophysiology and clinical outcome of this disease. Hence, the assessment of AS severity as well as its therapeutic management should be conducted with the use of a comprehensive evaluation that includes not only the aortic valve but also the systemic arterial system and the left ventricle, since these 3 entities are tightly intricated on both the pathophysiological and hemodynamic standpoints.