Should aortic valve replacement be performed in an 80-year-old person with symptomatic severe aortic stenosis?
Case Presentation An 80-year-old, previously functionally independent woman taking no medications has a 6-month history of substernal chest pressure precipitated by exertion and relieved by rest, an episode of syncope 2 months ago, and dyspnea at rest for the past 2 days. Physical examination in her physician’s office revealed a blood pressure of 110/80 mm Hg, a regular pulse at a rate of 96/minute, and a respiratory rate of 26/minute. Abnormal physical findings included a carotid pulse with a prolonged upstroke time, moist crepitant rales heard at both lung bases posteriorly, an absent A2, audible third and fourth heart sounds heard at the apex, and a grade 2/6 systolic ejection murmur heard in the second right intercostal space that radiated down the left sternal border to the apex and upwards to the right carotid artery. The systolic ejection murmur was prolonged in duration and peaked in the second half of systole. An electrocardiogram showed a regular sinus rhythm and left ventric
