eMedicine Specialties > Cardiology > Valvular Heart Disease

Aortic Stenosis: Follow-up

Author: John A McPherson, MD, FACC, FSCAI, Assistant Professor of Medicine, Division of Cardiovascular Medicine, Medical Director of Cardiovascular Intensive Care Unit, Vanderbilt Heart and Vascular Institute
Contributor Information and Disclosures

Updated: Aug 25, 2009

Follow-up

Further Outpatient Care

  • Follow-up of asymptomatic patients
    • The frequency of the follow-up visits in asymptomatic patients is determined by the severity of aortic stenosis and by the presence of comorbid conditions.
    • In patients with mild aortic stenosis, yearly history and physical examination and an echocardiogram every 3-5 years is appropriate.
    • Patients with moderate or severe aortic stenosis should be examined twice yearly and whenever they develop symptoms potentially attributable to aortic stenosis.
    • In patients with moderate aortic stenosis, echocardiograms should be performed every 2 years, whereas in asymptomatic patients with severe aortic stenosis, yearly echocardiograms are recommended.
  • Follow-up of symptomatic patients
    • The medical treatment options are limited in symptomatic patients who are not candidates for surgical intervention. In cases of pulmonary congestion, digitalis, diuretics, and ACE inhibitors might be used cautiously, whereas beta-blockers might be used if the predominant symptom is angina. In any case, excessive decrease in preload or systemic arterial blood pressure should be avoided. Onset of atrial fibrillation often requires prompt cardioversion.
    • Following aortic valve replacement, every patient should undergo echocardiographic examination after recovery. Thereafter, an examination is recommended whenever new symptoms develop that are attributable to a potential valvular dysfunction.
    • Patients with mechanical valves should receive lifelong anticoagulation with warfarin and should undergo periodic screening of their anticoagulation status.

Complications

Prognosis

See Mortality/Morbidity and Treatment.

Patient Education

For excellent patient education resources, visit eMedicine's Circulatory Problems Center. Also, see eMedicine's patient education article Angina Pectoris.

Miscellaneous

Medicolegal Pitfalls

  • Patients with severe valvular AS should receive appropriate counseling regarding their conditions, including restriction of physical activity and the need for surgery, if appropriate. Physicians should document these points in patients' records.
  • In cases where the patient refuses AV replacement surgery, the patient needs to have a full understanding of the potential implications (including sudden cardiac death) of his or her decision.
  • The patient who agrees to undergo aortic valve replacement needs to understand its possible consequences, including perioperative death, the need for lifelong anticoagulation depending on the type of prosthesis, the need for bacterial endocarditis prophylaxis, and the risk of prosthesis malfunction with potential need for reoperation at a higher operative risk.
  • Discussion and careful documentation of these issues not only would help patients become familiar with their condition and therapeutic options, but also would help to avoid misunderstandings and potential litigation.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors James V Talano, MD, MBA, MM, FACC, FAHA and Bekir Hasan Melek, MD to the development and writing of this article.



More on Aortic Stenosis

Overview: Aortic Stenosis
Differential Diagnoses & Workup: Aortic Stenosis
Treatment & Medication: Aortic Stenosis
Follow-up: Aortic Stenosis
Multimedia: Aortic Stenosis
References
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Further Reading

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Keywords

aortic stenosis, AS, valvular aortic stenosis, valvular AS, aorta stenosis, aortic valve surgery, heart failure, syncope, angina pectoris, pulsus parvus et tardus, heart valve obstruction, aortic obstruction, aortic valve obstruction, aortic valve replacement, AVR, sudden cardiac death, SCD, calcific embolization, infective endocarditis

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Contributor Information and Disclosures

Author

John A McPherson, MD, FACC, FSCAI, Assistant Professor of Medicine, Division of Cardiovascular Medicine, Medical Director of Cardiovascular Intensive Care Unit, Vanderbilt Heart and Vascular Institute
John A McPherson, MD, FACC, FSCAI is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, Society for Cardiac Angiography and Interventions, Society of Critical Care Medicine, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Alan D Forker, MD, Professor of Medicine, Program Director of Cardiovascular Fellowship, University of Missouri at Kansas City School of Medicine; Director, Outpatient Lipid Diabetes Research Center, MidAmerica Heart Institute of St Luke's Hospital
Alan D Forker, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Hypertension, and Phi Beta Kappa
Disclosure: Research Grant Grant/research funds Hospital contracts to do research; I am a hospital employee with no personal profit; Speakers Bureau Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Steven J Compton, MD, FACC, FACP, Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals
Steven J Compton, MD, FACC, FACP is a member of the following medical societies: Alaska State Medical Association, American College of Cardiology, and American College of Physicians
Disclosure: Nothing to disclose.

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Richard A Lange, MD, Professor and Executive Vice Chairman, Department of Medicine, University of Texas Health Science Center at San Antonio
Richard A Lange, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, and Association of Subspecialty Professors
Disclosure: Nothing to disclose.

 
 
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