Aortic Valve Disease Soner Sanioğlu, M.D. Assoc. Prof. of Cardivascular Surgery.
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Transcript of Aortic Valve Disease Soner Sanioğlu, M.D. Assoc. Prof. of Cardivascular Surgery.
Aortic Valve Disease
Soner Sanioğlu, M.D.Assoc. Prof. of Cardivascular Surgery
Anatomy
Pathophysiology
Laplace’s LawWT=PXR/2h
Aortic stenosis
• Dejenerative
• Bicuspid
• Rheumatic
Symptoms
• Angina pectoris: CPP=DAP-EDLVP (survival 5 y)
• Syncope: exercise→ fixed CO→ reduced
cerebral perfusion (survival 3 y)
• Dyspnea and heart failure: (survival 2 y)
Signs
• systolic ejection crescendo-decrescendo murmur
• Pulsus parvus et tardus
Echo
Medical treatment
• ß- blocer, HR↓ ejection time ↑
• Diuretic, pulmonary congestion ↓
Surgical indications
Aortic Regurgitation• Calcific aortic disease, • Idiopathic degenerative disease, • Active or chronic aortic valve endocarditis, • Rheumatic disease• Biscuspid aortic valve, • Myxomatous proliferation of aortic valve tissue • Anorectic medications, such as fenfluramine and phentermine, • Carcinoid syndrome.• Aortic annular dilatation: aortic dissection; trauma; chronic systemic
hypertension; aortitis from syphilis, viral syndromes, or other systemic arteritides (e.g., giant cell and Takayasu); and connective tissue disorders such as Marfan syndrome, Reiter disease, Ehlers-Danlos syndrome, osteogenesis imperfecta, and rheumatoid arthritis .
• Pure AR is rare and is seen commonly only in
aortic dissection or annular dilatation.
• Most commonly, aortic valvular insufficiency is
seen in combination with AS, e.g. rheumatic
valvular disease, or myxomatous degenerative
disease.
Symptoms
• Asymptomatic for prolonged periods of time
• Palpitations
• Chest pain
• Most symptoms of AR occur from underlying
heart failure and pulmonary congestion
• Dyspnea and PND, CHF.
Signs
Table 22.2 Signs of aortic insufficiency
Sign Finding
Corrigan’s pulse Rapid forceful carotid upstroke followed by rapid decline
Quincke’s pulse Systolic plethora and diastolic blanching in nail bed when nail is slightly compressed
de Musset’s sign Bobbing of head
Duroziez’s sign Systolic and diastolic bruit heard over femoral artery when compressed by bell of stethoscope
Hill’s sign Augmentation of systolic blood pressure in leg by ³30 mm Hg compared with that in arm
• Diastolic murmur• Austin Flint murmur, middiastolic apical
murmur
Medical treatment
• Vasodilator theraphy, SVR↓
• Diuretic, pulmonary congestion ↓