Vol. 13. Núm. 40.
Páginas 2291-2301 (Octubre 2021)

Actualización
Lesiones de la válvula aórtica

Aortic valve lesions

A. Matutano MuñozR. Garrido GonzálezA. Portolés HernándezJ. Segovia Cubero
Doi : https://10.1016/j.med.2021.09.001
Opciones
Resumen

La causa de la estenosis aórtica más frecuente actualmente en nuestro medio es la degenerativa calcificada. La principal herramienta para el diagnóstico y seguimiento de los pacientes es el ecocardiograma transtorácico, apoyándose en la ecografía transesofágica, la tomografía computarizada o la resonancia magnética en los escenarios complejos. Se debe intervenir sobre los pacientes con EA severa que desarrollen síntomas, disfunción sistólica del ventrículo izquierdo o presenten otros datos de mal pronóstico. El tratamiento de elección es el recambio valvular quirúrgico, si bien el abordaje percutáneo se ofrece como alternativa en pacientes con mayor riesgo quirúrgico.

La insuficiencia aórtica puede ser primaria o secundaria a enfermedades de la raíz aórtica o de la aorta ascendente. La ecocardiografía transtorácica es la técnica de elección para el diagnóstico y el seguimiento de los pacientes, que puede complementarse con estudio transesofágico, tomografía computarizada o resonancia magnética en determinadas situaciones. El tratamiento de elección es quirúrgico mediante reparación o sustitución valvular, y se indica en aquellos pacientes que desarrollan síntomas, disfunción sistólica o dilatación del VI. En determinados casos puede acompañarse de intervención sobre la raíz aórtica o la aorta ascendente.

Palabras clave
Valvulopatía aórtica
Estenosis aórtica
Insuficiencia aórtica
Imagen valvular multimodal
Intervención quirúrgica valvular
Abordaje percutáneo de valvulopatías
Reparación valvular
Abstract

Calcific degenerative stenosis is the most common cause of aortic stenosis in our setting. Transthoracic echocardiography is main tool for the diagnosis and follow-up of patients, along with transoesophageal echography, computed tomography, or magnetic resonance imaging in complex scenarios. Patients with severe AS who develop symptoms, left ventricular systolic dysfunction or other poor prognostic data require intervention. Surgical valve replacement is the treatment of choice, although the percutaneous approach is offered as an alternative in patients at higher surgical risk.

Aortic failure may be primary or secondary to aortic root or ascending aortic disease. Transthoracic echocardiography is the test of choice for the diagnosis and follow-up of patients, which can be complemented by transoesophageal study, computed tomography, or magnetic resonance imaging in certain situations. Surgical repair or valve replacement are the treatment of choice, and indicated in patients who develop symptoms, systolic dysfunction, or LV dilatation. In certain cases, it may be accompanied by intervention to the aortic root or ascending aorta.

Keywords
Aortic valve disease
Aortic stenosis
Aortic failure
Multimodality imaging for valves
Valve surgery
Percutaneous approach to valve diseases
Valve repair

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