Aortic Stenosis-Insufficiency Flashcards Preview

CVPR 312 Cardiac Pathophysiology > Aortic Stenosis-Insufficiency > Flashcards

Flashcards in Aortic Stenosis-Insufficiency Deck (29):
1

What are the 4 AORTIC ROOT anatomic components:

- The aortic annulus or aortoventricular junction
- The leaflets
- The aortic sinuses or sinuses of Valsalva
- The sinotubular junction

2

The morphologic characteristics and function of the aortic valve are interrelated to the aortic root and are best described as a single functional unit. The diameter of the aortic annulus is

15% to 20% larger than the diameter of the sinotubular junction.

3

Severe AS & normal cardiao output =

transvalvar gradient >50mmHg

4

normal aortic valve area =

3.0 to 4.0 cm2

5

MILD Aortic Stenosis
Mean Gradient :
Aortic Valve Area:

Mean Gradient : < 25
Aortic Valve Area: > 1.5

6

Moderate Aortic Stenosis
Mean Gradient :
Aortic Valve Area:

Mean Gradient : 25 - 40
Aortic Valve Area: 1.0 - 1.5

7

Severe Aortic Stenosis
Mean Gradient :
Aortic Valve Area:

Mean Gradient : > 40
Aortic Valve Area: < 1.0

8

Critical Aortic Stenosis
Mean Gradient :
Aortic Valve Area:

Mean Gradient : > 70
Aortic Valve Area: < 0.6

9

AS: Clinical Picture Symptoms

- Asymptomatic
- Syncope
- Angina
- CHF
- Sudden Death

10

HAEMODYNAMICALLY SEVERE
(symptomatic or asymptomatic)

- Sudden death risk high
- Immediate operation is indicated

11

HAEMODYNAMICALLY MILD – MODERATE (asymptomatic)

- 50% event free for 4 years
- Operation is not urgent, but patients should be followed carefully as the disease advances rapidly

12

HAEMODYNAMICALLY MILD – MODERATE (SYMPTOMATIC)

- One-third will die within 4 years
- Prompt operation is indicated

13

Natural History Progression average for Aortic Stenosis ?

0.1 cm2 per year

14

Management of Aortic Stenosis for an Asymptomatic patient (Mild - Moderate) ?

- Medical follow up
- Regular ECHO
- Avoid strenuous exercise
- Endocarditis prophylaxis
- ? Role for statins
- Progress ~0.1cm2 per year

15

Management of Aortic Stenosis for an Symptomatic patient with the following symptoms?
- Angina, syncope, failure
- Moderate AS + CAD
- Reduced BP on exercise
- Severe AS & reduced LV function

AVR

16

Infective endocarditis, Trauma, or
Iatrogenic cause leads to _________, which causes Aortic Regurgitation due to abnormalities of the leaflets.

Cusp Perforation

17

Excess of tissue, Disrupted commissure, and Commissural malposition leads to _________ which causes Aortic Regurgitation due to abnormalities of the leaflets.

Cusp prolapse

18

Fibrous thickening can lead to ________ which causes Aortic Regurgitation due to abnormalities of the leaflets.

Restrictive motion

19

4 Congenital Defects that lead to Aortic Regurgitation

- Bicuspid valve
- Supra-valvar stenosis
- Supra-cristal VSD and right coronary prolapse
- Sinus of Valsalva aneurysm

20

5 valve acquired diseases which lead to Cusp prolapse or cicatricial shortening of cusps with rolled edges which eventually lead to Aortic Regurgitaion ?

- Rheumatic fever
- Infective endocarditis
- Rheumatoid disease
- SLE
- Hurler’s syndrome

21

6 Aortic Root acquired diseases which lead to Dilation of sinus aorta and failure of coaptation of cusps which eventually lead to Aortic Regurgitaion ?

- Dissection
- Syphilis
- Cystic medial necrosis e.g Marfans – annulo-aortic ectasia
- Arthritides with aortitis e.g. Ankylosing spondylitis
- Hypertension
- Trauma

22

Medical MANAGEMENT of AR ?

- Calcium channel blocker
- Regular ECHO
- Avoid isometric exercise
- Endocarditis prophylaxis
- Monitor for symptoms
- Protracted course

23

Management of AR if patient is symptomatic ?

AVR

24

AR patient is asymptomatic if ?

- LVESD > 50-55mm
- LVEDD > 70-75mm
- LVEF < 55%

25

AVR very effective treatment even in patients over age

70 or 80

26

Even the best patients over age 80 have

reduced reserve

27

9 Increased risks during AVR if

-Emergency
- NYHA Class III – IV
- >65 years old
- Severe AS AVA70, LVEDP>20
- Impaired LV systolic function
- Need for other procedure (CABG)
- Renal dysfunction
- Small BSA
- Redo operation

28

Post op complications for AVR ?

- Operative mortality: ~ 5%
- Complete heart block
- Ischemic heart disease (6 months from coronary ostial
stenosis)
- CVA 3 – 5%

29

What is the percentage of 5 year survival prognosis for patients with normal LV function who underwent an AVR ?

96%