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At the recent annual meeting of the British Heart Valve Society, an invited speaker asked: Why has Aortic Stenosis become so complicated? This rhetorical question was posted on Twitter and liked and retweeted several hundred times. Until recently, aortic stenosis was perceived as a relatively simple heart valve disorder. The diagnosis was straightforward—hear a systolic murmur, demonstrate a withdrawal gradient on cardiac catheterisation or an increased velocity on echocardiography and the diagnosis was complete. If the patient was symptomatic, they were referred for the only available treatment—surgical aortic valve replacement. The surgeon saw them in the clinic and they were listed for surgery. If aged ≥70, then they received a tissue prosthesis, if aged <70, then a mechanical one.
With the dawning of a new millennium, came change—the realisation that with an ageing population, the incidence and prevalence of heart valve disease in high-income countries was, for the first time in half a century, since the successful control …
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