Aortic valve disease
The definition of aortic valve disease is limited to diseases that directly or indirectly affect the aortic valve. Thus, both conditions that directly damage the leaflets and annulus, as well as those that indirectly hinder their function are grouped in this pathology.
In order to better understand it, it is easier to divide it according to the established valve dysfunction:
Stenosis-type lesion: formation of a transvalvular systolic gradient and reduction of the effective flow area, or valve area.
Regurgitation-type lesion: formation of diastolic regurgitation from the aortic artery into the left ventricle, caused by poor coaptation of the leaflets at this point in the cardiac cycle.
Balanced lesion: presence of both dysfunctions, stenosis and regurgitation, leading to the formation of a complex involvement, which may have a predominance of some kind or be balanced. Balanced injuries are difficult to manage and classify, as current methods assess the hemodynamic aspects of the injury with limitations.
Another possible classification, which resembles the classification of mitral valve disease, is relative to being primary or secondary. This classification has little clinical effect, as different from the mitral valve, being primary or secondary does not interfere in the conduct of those patients, but it can have some benefit in the decision of the surgical technique as we can see in the table below, which classifies functional aortic regurgitation according to the specific involvement of the structures.
Thus, the functional etiology is that originated by the widening of the aortic annulus and, almost invariably, initial segments of the aorta. The dilation leads to failure of coaptation of the leaflets by their removal. The primary etiology is that in which we have direct involvement of the leaflet, such as rheumatic disease, endocarditis and the congenital etiology (bivalvular aortic disease).
1 – Otto CM, Bonow RO. A Valvular Heart Disease – A companion to Braunwald’s Heart Disease. Fourth Edition, 2014.