Calcific aortic stenosis: known facts and promising studies

Abstract

Calcific aortic stenosis is a common heart disease and the most common cause of surgical interventions on heart valves in old age. Eliminated course, nonspecific clinical symptoms, and late patients seeking surgical help, lead to high mortality, reaching 50 % over the next 5 years. Despite the frequent occurrence, our knowledge of this type of aortic defect remains incomplete. About 300 years ago A. Bonnet first described defect as a random isolated pathological finding in the corpse of a Parisian tailor. Later, R. Virchow designated ectopic calcification / ossification as the main cause of the development of the disease and put forward the theory of hematogenous drift. In 1904, J. G. Mönckeberg considered calcific aortic stenosis a manifestation of “senile degeneration” of valves and blood vessels. W. S. Roberts retrospectively correlated the classic triad of symptoms with the time of death of patients with aortic stenosis. The progress of cardiac surgery in the middle of the 20th century made it possible to describe in detail ectopic calcification as an active, progressive, recurrent and potentially modifiable process. In the works of the staff of the Nesterov’s department of facultative therapy demonstrated a high incidence of the disease in the population of the Russia. The main reason for the development of symptoms is a progressive obstruction of the exit tract of the left ventricle of the heart, its uneven hypertrophy, rhythm and conduction disturbances in combination with concomitant arterial hypertension and other comorbidities. A change in the nature of systolic murmur, underestimation of symptoms by doctors and patients themselves, the ambiguity of echocardiography data lead to late diagnosis of the disease and untimely surgical treatment. Disturbances of calcium and bone metabolism significantly reduce the functional status of patients, including due to an adverse effect on cardiac hemodynamics. Modern molecular genetic studies are aimed at finding possible ways to control a systemic inflammatory reaction, suppress lipid peroxidation, inhibit calcification and modify the osteogenic potential of interstitial cells of heart valves.

Keywords

• cardiovascular diseases
• valvular heart disease
• calcific aortic stenosis
• left ventricular hypertrophy
• angina pectoris
• syncope
• shortness of breath
• bone metabolism
• calcium metabolism
• molecular genetic studies