Pathology and prognosis of aortic stenosis in the elderly

Current results of the surgical treatment of aortic stenosis are gratifying. However, establishing the diagnosis of aortic stenosis in elderly patients can be difficult. First, systolic murmurs are a common finding in the elderly, and their potential significance in patients with angina, heart failure or spells of dizziness or lightheadedness may be underestimated. Second, calcific aortic stenosis in the elderly differs clinically and morphologically from typical aortic stenosis. Fortunately, the use of Doppler echocardiography has greatly enhanced our non-invasive diagnostic capabilities in recent years. A third important issue is the use of balloon valvuloplasty to relieve aortic stenosis; this technique has been applied successfully in congenital forms of aortic and pulmonic stenosis, as well as in rheumatic mitral stenosis, and its appropriate use in the management of calcific aortic stenosis in elderly patients warrants discussion.