AORTIC STENOSIS

INTRODUCTION
Aortic stenosis is the narrowing of the exit of the left ventricle of
the heart (where the aorta begins), such that problems result. It may
occur at the aortic valves well as above and below this level. It
typically gets worse over time.

DEFINITION
Aortic stenosis: Narrowing (stenosis) of the aortic valve, the valve
between the left ventricle of the heart and the aorta. This narrowing
impedes the delivery of blood to the body through the aorta and
makes the heart work harder. The need for surgery depends on the
degree of stenosis.
CAUSES
Congenital heart defect. The aortic valve consists of three tightly fitting,
triangular-shaped flaps of tissue called cusps. Some children are born
with an aortic valve that has only two (bicuspid) cusps instead of three.
People may also be born with one (unicuspid) or four (quadricuspid)
cusps, but these are rare.
Calcium buildup on the valve. With age, heart valves may accumulate
deposits of calcium (aortic valve calcification). Calcium is a mineral
found in the blood. As blood repeatedly flows over the aortic valve,
deposits of calcium can build up on the valve's cusps. These calcium
deposits aren't linked to taking calcium tablets or drinking calcium-
fortified drinks.
Rheumatic fever. A complication of strep throat infection, rheumatic
fever may result in scar tissue forming on the aortic valve. Scar
tissue alone can narrow the aortic valve and lead to aortic valve
stenosis. Scar tissue can also create a rough surface on which
calcium deposits can collect, contributing to aortic valve stenosis
later in life.
 PATHOPHYSIOLOGY
Due to etiological factor

Valve obstruction

Increase intraventricular pressure to maintain CO

Ventricular wall hypertrophy

Impaired passive filling

Subendocardial ischemia

Progressive wall obstruction

Increase filling pressure

Contractile dysfunction
CLINICAL MANIFESTATION
• Abnormal heart sound (heart murmur) heard through a
stethoscope
• Chest pain (angina) or tightness with activity
• Feeling faint or dizzy or fainting with activity
• Shortness of breath, especially when you have been active
• Fatigue, especially during times of increased activity
• Heart palpitations — sensations of a rapid, fluttering heartbeat
• Not eating enough (mainly in children with aortic valve stenosis)
• Not gaining enough weight (mainly in children with aortic valve
stenosis)
DIAGNOSIS
 Echocardiogram
 Electrocardiogram
 Chest X-ray
 Exercise tests or stress tests
 Cardiac computerized tomography (CT) scan
 Cardiac MRI
 Cardiac catheterization
MANAGEMENT
• Treatment also focuses on conditions often seen in mitral stenosis:
• Any angina is treated with short-acting nitro vasodilators, beta-
blockers and/or calcium blockers
• Any hypertension is treated aggressively, but caution must be taken in
administering beta-blockers
• Any heart failure is treated with digoxin, diuretics, nitro vasodilators
and, if not contraindicated.
SURGICAL MANAGEMENT
Aortic valve repair
surgeons rarely repair an aortic valve to treat aortic valve stenosis, and
generally aortic valve stenosis requires aortic valve replacement. To
repair an aortic valve, surgeons may separate valve flaps (cusps) that
have fused.
Balloon valvuloplasty
Doctors may conduct a procedure using a long, thin
tube (catheter) to repair a valve with a narrowed
opening (aortic valve stenosis). In this procedure,
called balloon valvuloplasty, a doctor inserts a
catheter with a balloon on the tip into an artery in
the arm or groin and guides it to the aortic valve.
The doctor performing the procedure then inflates
the balloon, which expands the opening of the valve.
The balloon is then deflated, and the catheter and
balloon are removed.
Aortic valve replacement
Aortic valve replacement is often needed to treat aortic valve stenosis.
In aortic valve replacement, surgeon removes the damaged valve and
replaces it with a mechanical valve or a valve made from cow, pig or
human heart tissue (biological tissue valve).
COMPLICATIONS
• Aortic valve stenosis can cause complications, including:
• Heart failure
• Stroke
• Blood clots
• Bleeding
• Heart rhythm abnormalities (arrhythmias)
• Infections that affect the heart, such as endocarditis
• Death
PREVENTION
• Some possible ways to prevent aortic valve stenosis include:
• Taking steps to prevent rheumatic fever. You can do this by making sure
you see your doctor when you have a sore throat. Untreated strep throat
can develop into rheumatic fever. Fortunately, strep throat can usually be
easily treated with antibiotics. Rheumatic fever is more common in
children and young adults.
• Addressing risk factors for coronary artery disease. These include high
blood pressure, obesity and high cholesterol levels. These factors may be
linked to aortic valve stenosis, so it's a good idea to keep weight, blood
pressure and cholesterol levels under control if the patient have aortic
valve stenosis.
• Taking care of teeth and gums. There may be a link between infected
gums (gingivitis) and infected heart tissue (endocarditis). Inflammation of
heart tissue caused by infection can narrow arteries and aggravate aortic
valve stenosis.
• Once patient know that He/She have aortic valve stenosis, the doctor may
recommend that limit strenuous activity to avoid overworking heart.
THANK YOU