Aortic valve disease.

There have been several significant advances in our understanding of aortic valve disease over the past year. Recent studies suggest that "degenerative" valvular aortic stenosis is an active disease process rather than an inevitable consequence of aging. In the diagnostic evaluation of patients with aortic stenosis, detailed studies of the changes in valve area with changes in flow rate and the subaortic flow profile have been performed. In addition, the myocardial response to chronic pressure overload has been studied in further detail including gender differences in the response to chronic pressure overload. Aortic regurgitant severity can now be quantitated more precisely using simplified measures of regurgitant fraction based on Doppler and color flow imaging techniques. The optimal timing of surgical repair in chronic aortic regurgitation continues to be a topic of interest, with additional studies recommending surgical intervention prior to the development of an irreversible decrease in left ventricular contractility. Most importantly, two randomized trials of afterload reduction for preventing left ventricular dilation and symptom onset in aortic regurgitation have been performed, with the data supporting long-term afterload reduction in this patient group.