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Answer 2
  1. Cardiology Consultation for invasive coronary angiography prior to planned aortic valve replacement. The development of symptoms attributable to aortic stenosis–angina, syncope, or heart failure–is a significant prognostic turning point in the disease course and warrants assessment for surgery. Medical therapy has not been demonstrated to alter the natural history of sever aortic stenosis. In the absence of surgical aortic valve replacement, the presence of angina, syncope, or heart failure is associated with a 50% mortality at 5, 3, and 2 years, respectively.2 Exercise stress testing is contraindicated in patients with symptomatic sever aortic stenosis due to a high rate of complications and low diagnostic accuracy. Given the overlap of risk factors with coronary artery disease, invasive coronary angiography should be performed prior to aortic valve replacement to assess whether concomitant coronary artery bypass grafting is necessary. Statin therapy has demonstrated no benefit for prevention off progression of sever aortic valve calcification and should not be initiated for this purpose.3

    2. Otto C, Benow R. Valvular heart disease. In: Libby P, Bonow R, Zipes DP, Mann DL, editors. Braunwald’s heart disease: a textbook of cardiovascular medicine, 8th ed. New York: Saunders; 2008:1625–93.
    3.  Bonow RO, Carabello BA, Chatterjee K, et al. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease). J Am Coll Cardiol 2008;52(13):el–142.

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