Calcific aortic valve disease

Calcific Aortic Valve Disease (CAVD) is a progressive condition characterized by the accumulation of calcium deposits on the aortic valve in the heart, leading to its stiffening and reduced functionality. This disease is a primary cause of aortic stenosis and is associated with significant morbidity and mortality among affected individuals, particularly in the elderly population.

Etiology

The exact cause of CAVD is multifactorial, involving a combination of genetic predisposition, environmental factors, and associated risk factors. Key risk factors include advanced age, smoking, hypertension, elevated cholesterol levels, and diabetes mellitus. The pathogenesis of CAVD is complex and involves inflammation, lipid accumulation, and active leaflet calcification.

Pathophysiology

In CAVD, the normal aortic valve leaflets undergo a series of changes that lead to calcification and reduced leaflet mobility. Initially, there is a buildup of lipids and inflammatory cells within the valve leaflets, followed by the activation of osteoblast-like cells that deposit calcium. This process is similar to bone formation and leads to the stiffening of the valve leaflets, reducing their ability to open and close properly. As a result, the heart must work harder to pump blood through the narrowed valve, leading to symptoms and complications associated with aortic stenosis.

Clinical Presentation

Patients with CAVD may be asymptomatic for many years until the valve narrowing becomes severe. Symptoms of advanced CAVD or aortic stenosis include:

• Dyspnea (shortness of breath) on exertion
• Angina pectoris (chest pain)
• Syncope (fainting spells)
• Heart failure symptoms such as fatigue, edema, and difficulty breathing

Diagnosis

Diagnosis of CAVD involves a thorough clinical evaluation, including a physical examination and the use of diagnostic imaging techniques. Key diagnostic tools include:

• Echocardiography: A primary tool for assessing valve structure, function, and the severity of stenosis.
• Cardiac CT and MRI: Used for detailed imaging of the valve and assessment of calcification.
• Cardiac catheterization: May be used in certain cases to assess the severity of stenosis and plan for potential interventions.

Treatment

Treatment options for CAVD depend on the severity of the disease and the presence of symptoms. Management strategies include:

• Medical management: Aimed at controlling symptoms and associated conditions such as hypertension and hyperlipidemia.
• Surgical aortic valve replacement (SAVR): Indicated for symptomatic patients with severe stenosis.
• Transcatheter aortic valve replacement (TAVR): A less invasive option for patients who are at high risk for surgical complications.

Prognosis

The prognosis for patients with CAVD varies depending on the stage of the disease and the presence of symptoms. Without intervention, symptomatic severe aortic stenosis has a poor prognosis. However, with appropriate treatment, including valve replacement in severe cases, many patients can experience significant improvement in symptoms and quality of life.

Prevention

Preventive measures for CAVD focus on controlling risk factors and include lifestyle modifications such as smoking cessation, maintaining a healthy weight, regular exercise, and managing conditions like hypertension and diabetes.