BACKGROUND Aortic valve stenosis (with or without aortic regurgitation and without associated mitral stenosis) in adults in the Western world has been considered in recent years to most commonly be the result of degenerative or atherosclerotic disease. METHODS AND RESULTS We examined operatively excised, stenotic aortic valves from 932 patients aged 26 to 91 years (mean+/-SD, 70+/-12), and no...

BACKGROUND 3D stereolithographic printing can be used to convert high-resolution computed tomography images into life-size physical models. We sought to apply 3D printing technologies to develop patient-specific models of the anatomic and functional characteristics of severe aortic valve stenosis. METHODS AND RESULTS Eight patient-specific models of severe aortic stenosis (6 tricuspid and 2 b...

The report from Belgium (1) and the accompanying editorial from Sweden (2) complain, rightly, that the published indications for intervention for asymptomatic severe aortic stenosis are in conflict. American guidelines (3) require a valve area 1 cm and a mean gradient 40 mm Hg, whereas Otto et al. (4) required a peak velocity 4 m/s that predicts a gradient of 64 mm Hg. The European guidelines (...

This issue provides a clinical overview of aortic stenosis, focusing on screening, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in col...

BACKGROUND In an era of expanded treatment options for severe aortic stenosis, it is important to understand risk factors for the condition. It has been suggested that severe aortic stenosis is less common in African Americans, but there are limited data from large studies. METHODS AND RESULTS The Synthetic Derivative at Vanderbilt University Medical Center, a database of over 2.1 million de-...

The introduction of aortic valve surgery has made the assessment of aortic valve disease increasingly important, and attention has been focused on the arterial pulse as an aid to diagnosis. Experimental studies on aortic stenosis were carried out by De Heer in 1912 and later by Allan (1925) and by Katz, Ralli, and Cheer (1928), who showed that an increasing systolic pressure gradient across the...

Although the annual risk of cardiovascular mortality has been well described for individuals with symptomatic aortic stenosis, the morbidity and mortality for those with asymptomatic severe aortic stenosis is not as well known. Currently the American Heart Association/American College of Cardiology recommends a “watchful waiting” strategy for those with asymptomatic aortic stenosis.1 This invol...

BACKGROUND Severe congenital aortic stenosis in infants is a life-threatening congenital heart anomaly that is typically treated using percutaneous balloon aortic valvuloplasty. METHODS The usual route is the femoral artery under radiographic guidance. However, this procedure may be limited by the small size of the femoral artery in low-weight infants. An infant weighing only 7 kg with severe...

BACKGROUND The diagnosis of Immunoglobulin G4 (IgG4)-related disease (IgG4-RD), in general, depends on serum IgG4 concentrations and histopathological findings; therefore, diagnosis of IgG4-RD in cardiovascular organs/tissues is often difficult owing to the risk of tissue sampling. METHODS Prevalence of IgG4-positive lymphoplasmacytic infiltration in 103 consecutive cardiovascular surgical sa...

To preserve the quality of life as the population ages, it is important to identify and treat appropriately diseases that are commonly encountered in the elderly. It is estimated that approximately 28,000 aortic valve replacements were performed in the USA in 1994, with aortic stenosis being the most common indication; 61% of these aortic valve replacements occurred in patients over 65 years of...