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Aortic valvedisease
- 1. Aortic Valve Disease Kazakh national medical universit y Almaty Created by :- IMRAN KHAN GROUP 44 a
- 2. Lecture Outline Aortic Stenosis Aortic Regurgitation Etiology Pathophysiology Clinical Features Diagnostic Testing Differential Diagnosis Management
- 3. Aortic Stenosis: Pathology Normal Congenital Acquired Sources Undetermined
- 5. Aortic Stenosis: Pathophysiology Measuring severity: valve area – Severe ≤ 1.0 cm² – Moderate 1.0 – 1.4 cm² – Mild > 1.5 cm²
- 6. Left Ventricular Pressure Overload Global gene activation Concentric hypertrophy Gradient between LV and Aorta Source Undetermined
- 7. Aortic Stenosis: Clinical Findings • Dyspnea • Angina pectoris • Syncope Heart Rate (bpm) Systemic Arterial Pressure (mmHg) Pulmonary Arterial Pressure (mmHg) Pressure Aortic sten osis Volume Normal Source Undetermined M. Shea
- 8. Normal Parvus et tardus pulse Carotid Pulse Sources Undetermined
- 9. Aortic Stenosis Laboratory Evaluation Chest radiology Electrocardiography Echocardiography Stress testing Catheterization
- 10. Aortic Stenosis: Chest radiology Sources Undetermined
- 12. Echocardiography: Short Axis Normal: Aortic Stenosis Source Undetermined Source Undetermined
- 13. Aortic Valve Stenosis: Echo Findings Leaflet changes: • Thickening • Calcification • Mobility Ventricular changes: • Left ventricular hypertrophy Doppler changes: • valve gradient / valve area
- 14. Aortic Stenosis: Differential Diagnosis Any systolic murmur Adapted by University of Michigan, Gray’s Anatomy, wikimedia commons
- 15. Aortic Stenosis: Management • Young patient – Balloon valvotomy – Ross procedure • Adults – Valve replacement
- 16. Cribier-Edwards Percutaneous Valve medGadgetSource Undetermined Source Undetermined
- 18. Aortic Regurgitation: Etiology Abnormalities of valve leaflets • Rheumatic • Endocarditis • Bicuspid valve Dilatation of aortic root • Aortic aneurysm/dissection • Annulo-aortic ectasia • Marfan syndrome • Syphilis
- 19. Normal Valve Function: • Total cusp area > aortic root area by 1.8 x • Allows leaflets to overlap/abut • Helps prevent prolapse in diastole Impact of Diseases: • Rheumatic: Cusp area central defect • Endocarditis: Destroys cusp by tears • Aortic root: Dilation central defect Aortic Valve Regurgitation: Pathophysiology
- 20. Dominant Hemodynamics: LV volume overload • Critical determinant of severity - area of regurgi tant orifice area • End diastolic volume increases & stroke volum e increases • Dilation and hypertrophy of LV • Diastolic burden reaches critical point leadin g to heart failure • Low diastolic blood pressure: incomp. valve an d vasodilation Aortic Valve Regurgitation: Pathophy siology
- 21. Aortic Valve Regurgitation: Pathophysiology - Acute vs. Chronic Pulmonary Congestion Pressure Pressure N- Pressure Pressure N- Brown University
- 22. Aortic Regurgitation: Clinical Features • Long course • Palpitations • Dyspnea • Fatigue • Angina pectoris
- 23. The Arterial Pulse and Blood Press ures in Aortic Regurgitation Mild Moderate Severe 132/76 144/67 152/58 BloodPressure(mm/Hg 160 140 120 100 80 60 40 M. Shea
- 24. Hyperkinetic pulse Carotid Pulse Source Undetermined Source Undetermined
- 25. • LV apex impulse: displaced laterally, downwa rd, dynamic, enlarged • Systolic murmur: may or may not imply valve stenosis…rapid ejection of stroke volume acr oss aortic valve • Diastolic murmur: decrescendo murmur; valv ular AR - louder LUSB. Aortic root disease - l ouder RUSB Aortic Valve Regurgitation: Physical Examination
- 26. Aortic Regurgitation Laboratory Evaluation • Chest radiology • Electrocardiography • Echocardiography • Exercise testing • Cardiac catheterization
- 27. Aortic Regurgitation: Chest X-ray Source Undetermined
- 29. Aortic Regurgitation: Differential Diagnosis • Mitral stenosis • Pulmonic regurgitation • Patent ductus arteriosus
- 31. Aortic Regurgitation: Management Medical Therapy • Noninvasive follow-up
- 32. Aortic Regurgitation: Management Surgical Therapy Repair • Aortic valve Replacement • Aortic root replacement