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 ↓