Estenose aórtica grave: pontos de interesse para o Internista na orientação terapêutica
Palavras-chave:
Estenose aórtica, critérios ecográficos, grave, ligeira, sintomática, doença degenerativa, processo inflamatórioResumo
A estenose aórtica (EA) é a doença valvular mais comum do mundo
ocidental e a que mais frequentemente necessita de substituição
valvular. A prevalência aumenta com a idade, afectando cerca de
2 a 7% da população idosa. Quando a gravidade da EA é ligeira
a moderada, a doença é bem tolerada e, habitualmente, não é
acompanhada por sintomatologia. Quando evolui para grave, a EA
está associada a morbilidade e mortalidade significativas.
Convencionalmente, a EA tem sido considerada um processo
degenerativo, em que os danos da válvula resultam do desgaste.
Contudo, apenas uma minoria de indivíduos idosos desenvolve
EA, não sendo esta inevitável mesmo nas válvulas bicúspides.
Para além da degenerescência relacionada com a idade, outros
factores parece estarem envolvidos no desenvolvimento de EA.
A análise da relação risco-beneficio relativa à cirurgia valvular
favorece a precocidade da intervenção cirúrgica, dado o desenvolvimento da técnica cirúrgica e consequente redução do risco
de substituição valvular.
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Referências
Alec Vahanian et al. Guidelines on the management of valvular heart disease. European Heart Journal 2007; 28: 230-268.
Mohler ER, Sheridan MJ, Nicholas R, Harvey WP and Waller BF. Development and progression of aortic valve stenosis: atherosclerosis risk factors – a causal relationship? A clinical morphologic study. Clin Cardiol 1991; 14:995-996.
Hoagland PM, Cook F, Flatey M, Walker C and Goldman L. Case-control analysis of risk factors for presence of aortic stenosis in adults. Am J Cardiol 1985; 55:744-747.
Wilmshurst PT, Stevenson RN, Griffiths H and Lord JR. A case-control investigation of the relation between hyperlipidemia and calcify aortic stenosis. Heart 1997; 78:475-479.
Peltier M, Trojette F, Enriquez-Sarano M, Grigioni F, Slama M and Tribouilloy C M. Relation between cardiovascular risk factors and nonrheumatic severe calcific stenosis among patients with a three-cuspid aortic valve. Am J Cardiol 2003; 91:97-99.
Blase A C et al. Evaluation and Management of patients with aortic stenosis. Circulation 2002; 22:123-126.
Faggiano P, Antonini-Canterin F. and Erlicher A et al. Progression of aortic valve sclerosis to stenosis. Am J Cardiol 2003; 91:99-101.
Cosmi JE, Kort S and Tunick PA et al. The risk of development of aortic stenosis in patients with “benign” aortic valve thickening. Arch Intern Med 2002; 162:2345-2347.
Palta S, Pai A M, Gill K S and Pai R G. New insights into the progression of aortic stenosis: implications for secondary prevention. Circulation 2000; 101:2497-2502.
Bonow et al. ACC/AHA Practice Guidelines of Aortic stenosis. JACC 2006; 48: 1-148.
Novaro GM, Tiong IY, Pearce GL, Lauer MS, Sprecher DL and Griffin BP. Effect of hydroxymethylglutaryl coenzyme-A reductase inhibitor treatment, and progression of aortic stenosis. Circulation 2001; 104:2205-2209.
Pohle K, Maffert R and Ropers D et al. Progression of aortic valve calcification. Association with coronary atherosclerosis and cardiovascular risk factors. Circulation 2001; 104:1927-1932.
Shavelle D M, Junichuro T, Budoff M J, Mao S, Zhao X Q and O’Brien K D. HMG CoA reductase inhibitor (statin) and aortic valve calcium. Lancet 2002; 359:1125-1126.
Otto CM, BurWash IG, Legget ME et al. A prospective study of asymptomatic valvular aortic stenosis: clinical, echocardiography and exercise predictors of outcome. Circulation 1997; 95: 2262-2270.
Connolly HM, Oh JK, Schaff H V et al. Severe aortic stenosis with low transvalvular gradient and severe left ventricular dysfunction: result of aortic valve replacement in 52 patients. Circulation 2000; 101:1940-1946.
Amato MCM, Moffa PJ, Werner KE and Ramires J A F. Therapeutic decision asymptomatic aortic stenosis: the role of exercise testing. Heart 2001; 86:381-386.
Lindblom D, Lindblom U Quist J et al. Long-term relative survival rates after valve replacement. J Am Coll Cardiol 1990; 15:566-573.
Rosenhek R, Binder T, Porenta G et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med 2000; 343: 611-617.
Bergler-Klein J, Mundigler G, Pibarot P et al. Circulation 2007; 115; 2799-2800.
Lim P, Monin JL, Monchi M, Garot J et al. Predictors of outcome in patients with severe aortic stenosis and normal left ventricular function: role of B-type natriuretic peptide. European Heart Journal 2004; 25: 2048-2053.
deFilippi CR, Willett DL, Brickner ME et al. Usefulness of dobutamine echocardiography in distinguishing severe from nonsevere valvular aortic stenosis in patients with depressed left ventricular function and low transvalvular gradients. Am J Cardiol 1995; 75: 191-194.
Monin JL, Quere JP, Monchi M et al. Low-gradient aortic stenosis, operative risk stratification and predictors for long term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation 2003; 108: 319-324.
Nishimura RA, Grantham JA, Connolly HM, Schaff HV, Higano ST, Holmes Dr Jr. Low-output, low gradient aortic stenosis in patients with depressed left systolic function: the clinical utility of the dobutamine challenge in catheterization laboratory. Circulation 2002; 106: 809-813.
Lancellotti P, Lebois F, Simon M, Tombeux C, Chauvel C, Pierard LA. Prognostic importance of quantitative exercise Doppler echocardiography in asymptomatic valvular aortic stenosis. Circulation 2005; 108: 1713-1717.
Chan KL et al. Is aortic stenosis a preventable disease? J Am Coll Cardiol 2004; 1:13-17.
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Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição 4.0.
Direitos de Autor (c) 2023 Medicina Interna
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