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无症状重度主动脉瓣狭窄的评估管理及干预时机
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Abstract:
主动脉瓣狭窄(Aortic valve stenosis, AS)是一种常见的心脏瓣膜疾病，多见于老年人。根据目前的指南，建议对有症状的重度AS进行干预。然而，高达50%的重度AS患者在诊断时没有症状，当症状出现或出现左心功能不全时，可以考虑进行主动脉瓣置换术，但支持这些指征的证据有限。无症状重度AS的最佳干预时机和方式仍存在争议。在某些情况下，在亚临床不可逆心肌损伤发生之前，某些群体越来越多地支持早期手术干预。此外，随着经皮和外科手术方法的不断进步，死亡率和围手术期并发症的显著减少，许多研究者主张对这些患者进行早期干预。本综述重点介绍了对无症状重度主动脉瓣狭窄的当代评估和处理，并总结了目前关于此类患者早期手术的最佳介入时机和适应症的科学证据。
Aortic valve stenosis (AS) is a common heart valvular disease, which is more common in the elderly. According to the current guidelines, intervention for severe symptomatic AS is recommended. However, up to 50 percent of patients with severe AS are asymptomatic at the time of diagnosis, and aortic valve replacement can be considered when symptoms or left ventricular insufficiency occur, but there is limited evidence to support these indications. The best time and method of interven-tion for asymptomatic severe AS are still controversial. In some cases, some groups increasingly support early surgical intervention before subclinical irreversible myocardial injury occurs. In ad-dition, with the continuous progress of percutaneous and surgical methods and the significant re-duction of mortality and perioperative complications, many researchers advocate early interven-tion for these patients. This review focuses on the contemporary evaluation and management of asymptomatic severe aortic stenosis and summarizes the current scientific evidence for the best timing and indications of early intervention for such patients.
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