Tumors of the right heart have to be considered in the differential diagnosis of unexplained dyspnea in elderly patients. Transthoracic echocardiography is certainly necessary and mostly available diagnostic tool that can be of great help in diagnosing heart tumor as well as planning cardiac surgery, as it provides in most cases excellent visualization of the tumor and its relationship with other parts of the heart.

CALCIFIC AROTIC STENOSIS AND ATHEROSCLEROSIS: Aortic stenosis is the most frequent valvular heart disease in western world and its incidence continues to rise. Aortic sclerosis is the first characteristic lesion of the cusps, which is today considered a process similar to atherosclerosis. The progression of the disease is an active process leading to forming of bone matrix and heavily calcified stiff cusps by inflammatory cells and osteopontin. Aortic stenosis is a chronic, progressive disease which can remain asymptomatic for a long time even in the presence of severe aortic stenosis. MEDICAL TREATMENT FOR AORTIC STENOSIS: The need for alternative to aortic valve surgery is highlighted by increasing longevity of the population and new therapeutic strategies to limit disease progression are needed to delay or potentially avoid, the need for valve surgery. Currently, there are no established disease modifying treatments in regard to the progression of aortic stenosis. The first results about influence of angiotensin-converting enzyme inhibitors and statins on aortic sclerosis and stenosis progression are promising. Statins are likely to reduce cardiovascular events rather than disease progression, but may be potentially a valuable preventive treatment in these patients. The prejudice against the use of angiotensin-converting enzyme inhibitors by patients with aortic stenosis is changing. The cautious use of angiotensin-converting enzyme inhibition by patients with concomitant hypertension, coronary artery disease, and heart failure seems appropriate. Definite evidence from large clinical trials is awaited.

Aortic stenosis is the most frequent valvular heart disease. Aortic sclerosis is the first characteristic lesion of the cusps, which is considered today as the process similar to atherosclerosis. Progression of the disease is an active process leading to forming of bone matrix and heavily calcified stiff cusps by inflammatory cells and osteopontin. It is a chronic, progressive disease which can remain asymptomatic for a long time even in the presence of severe aortic stenosis. Proper physical examination remains an essential diagnostic tool in aortic stenosis. Recognition of characteristic systolic murmur draws attention and guides further diagnosis in the right direction. Doppler echocardiography is an ideal tool to confirm diagnosis. It is well known that exercise tests help in stratification risk of asymptomatic aortic stenosis. Serial measurements of brain natriuretic peptide during a follow-up period may help to identify the optimal time for surgery. Heart catheterization is mostly restricted to preoperative evaluation of coronary arteries rather than to evaluation of the valve lesion itself. Currently, there is no ideal medical treatment for slowing down the disease progression. The first results about the effect of ACE inhibitors and statins in aortic sclerosis and stenosis are encouraging, but there is still not enough evidence. Onset symptoms based on current ACC/AHA/ESC recommendations are I class indication for aortic valve replacement. Aortic valve can be replaced with a biological or prosthetic valve. There is a possibility of percutaneous aortic valve implantation and transapical operation for patients that are contraindicated for standard cardiac surgery.

The levels of natriuretic peptides were significantly higher in the patients with symptomatic aortic stenosis, and increased with NYHA class. Measurement of natriuretic peptides levels could be important addition to clinical and echocardiographic assesment in determing optimal timing for valve replacement in aortic stenosis.