Flashcards in Outflow obstruction Deck (17):
What is aortic stenosis?
the aortic valve leaflets are partly fused together
there may be 1 to 3 aortic leaflets, leading to restrictive exit from the LV
aortic stenosis may not be associated with an isolated lesion, there may be mitral valve stenosis and coarctation of the aorta and these must be excluded
what are the clinical features of aortic stenosis?
present with an asymptomatic murmur
severe: reduced exercise tolerance, chest pain, syncope
neonatal: heart failure, duct dependent circulation
What are the physical signs of aortic stenosis?
slow rising pulse
ejection systolic murmur maximal at upper right sternal edge
delayed soft aortic second sound
apical ejection click
What investigations are performed is aortic stenosis is suspected?
CXR: normal or post stenotic dilatation of the aorta
ECG: LVH, deep S wave in V2 and tall R in V6, downgoing T wave suggests severe stenosis
Management of aortic stenosis
regular clinical and echo assessment is required to determine when to intervene
symptomatic children: balloon valvotomy
children with significant stenosis often require aortic valve replacement
What is Pulmonary stenosis
leaflets are partly fused together leading to restrictive exit from the RV
What are the clinical features of pulmonary stenosis?
Physical signs of pulmonary stenosis
an ejection systolic murmur best heard at upper left sternal edge, thrill may be present
an ejection click
soft or absent p2
severe lesion: prolonged RV impulse with delayed valve closure
pulmonary stenosis investigations
CXR: normal or post stenotic dilatation
ECG: RVH, upright T wave in V1
pulmonary stenosis management
transcatheter balloon dilatation required when pressure across the pulmonary valve becomes markedly increased
coarctation of the aorta
not duct dependent, uncommon lesion
clinical features of coarctation of the aorta
systemic HTN in right arm
ejection systolic murmur upper right sternal edge
collateral supply towards posterior
radio-femoral delay due to collateral supply
investigations for coarctation of the aorta
CXR: 'rib notching' due to large collateral intercostal arteries.
3 sign, visible notch at site of coarctation
ECG: LVH, deep S wave in V2 and tall R in V6, downgoing T wave
palpate for absent femoral pulses in children
management for coarctation of the aorta
echo, when severe insert stent
what is interruption of the aortic arch?
severe coarctation with no connection between the aorta proximally and distally
VSD also usually present
presents in neonatal period
features of duct dependent circulation
what is hypoplastic left heart syndrome?
underdevelopment of the entire left side of the heart
mitral valve is small
LV is diminutive
aortic valve is abnormal