Rétrécissement aortique calcifié : aspects cliniques, exploration échocardiographique et prise en charge thérapeutique

Aortic stenosis (AS) is the most common valvular heart disease in developed countries and represents a major public health issue due to the aging population. Severe AS is defined as an aortic valve area < 1 cm2 or < 0,6 cm2 / m2 of body surface area. The classic symptoms of severe AS (angina, dyspnea, syncope) occur at an advanced stage of the disease, following a long asymptomatic period. As soon as symptoms appear, the prognosis of severe AS becomes dismal. Transthoracic echocardiography is the key examination to confirm the diagnosis, to assess the severity but also to appreciate the repercussions of aortic stenosis on left ventricular function. To date, there is no medical therapy, which proved to be efficient to prevent AS progression. The only curative treatment is aortic valve replacement (AVR), allowing a spectacular functional and prognostic improvement. AVR can be performed either surgically, either by percutaneous method. Current guidelines recommend AVR for severe AS in symptomatic patients or when there is left ventricular function impairment (left ventricular ejection fraction < 50%). If everyone agrees for the management of symptomatic patients with severe AS (class I surgical indication), management of asymptomatic severe AS remains a matter of controversy. The new percutaneous interventional techniques (Transcatheter Aortic Valve Replacement, TAVR), currently in full development, have already led to extend indications of AVR to patients previously deemed inoperable or at high operative risk.