Aortic Valve Area Index

> It is generally believed that, (aortic valve) organic disease being once established … is progressive … must end in death, either by rupture of the valves, organic disease of the remaining portion of the heart, or obstruction to the current of blood. … but … this disorganizing process may be occasionally of singular slowness, so that the patient may live for many years in the enjoyment of good, or at least tolerable health, or that the diseased action is really arrested and the lesion becomes stationary.Thus, did William Stokes categorize the uncertain natural history of aortic stenosis (AS) more than a century and half ago.1 Since his elegant description, AS has remained an enigmatic problem, particularly in the absence of symptoms. On one hand, the presence of typical symptoms and a peak transaortic velocity of >4 m/s and a valve area of 50 years ago.2 In the absence of symptoms, however, the relation between aortic valve area (AVA) and prognosis becomes much less certain; every cardiologist struggles with the question of when (if at all) to intervene upon such patients. Will their fate “end in death” as Stokes lamented or will they be among the fortunate who “live for many years… (as) the lesion becomes stationary.”See …