[Calcific and degenerative aortic stenosis--pathogenesis and new possibilities of treatment]

Abstract

Currently, degenerative changes are the most important cause of valvular aortic stenosis. Epidemiological as well as experimental studies suggest that inflammatory process induced and intensified by common atherosclerosis risk factors as age, hyperlipidemia, diabetes, hypertension, male sex and smoking, is responsible for these changes. Microscopic examination of the affected valves reveals: endothelium derangement, thickening of the subendothelial layer, intra- and extracellular lipid, lipoprotein and protein deposits, inflammatory infiltrate composed of macrophages, T lymphocytes, foam cells and intensive calcification in the zones of lipid accumulation. The method of choice in the assessment of aortic valve stenosis is echocardiography. New, more sensitive, quantitative radiological methods like Electron Beam Computed Tomography and Multislice Computed Tomography may be useful in a detection of early lesions and monitoring of their progress. As the process of aortic valve degeneration is long and progressive in nature, early introduction of effective prevention would decrease the number of patients operated on for aortic stenosis. A number of studies indicate the role of statins in slowing the progression of aortic valve degeneration. Nevertheless, no large randomized prospective study has emerged in this field and there is no strong enough evidence for the efficacy of statins in degenerative aortic valve disease.