AORTIC STENOSIS

PRIYA THOMAS
DEFINITION

Aortic stenosis refers to the

narrowing or obstruction of
blood flow through the valve.
INCIDENCE

Aortic stenosis is relatively uncommon, affecting

about 6 of every 1000 babies born
occurring more often in boys with a ratio of 3:1
BICUSPID aortic valve is the most common heart
lesion
CAUSES

Offspring of affected parents

Genetic defect such as bicuspid aortic valve
Common in patients with turners syndrome
TYPES

Subvalvar aortic stenosis refers to a narrowing or

obstruction below the valve.
Valvar aortic stenosis refers to a narrowing or
obstruction at the valve.
Supravalvar aortic stenosis refers to a narrowing or
obstruction above the valve.
PATHOPHYSIOLOGY

The leaflets are thickened and the commissures are fused to varying
degree

LV systolic pressure is increased as a result of the obstruction to out flow

Ventricular wall hypertrophies, as its compliance decreases, end-diastolic

pressure increases
SYMPTOMS

Chest pain (angina) or tightness

Feeling faint or fainting with exertion
Shortness of breath, especially with exertion
Fatigue, especially during times of increased activity
Heart palpitations sensations of a rapid, fluttering
heartbeat
Heart murmur
Cont

Ejection click: Common in children and young adults with congenital aortic
stenosis. High-pitched sounds that occur at the moment of maximal opening of
the aortic or pulmonary valves
Prominent S4: Resulting from forceful atrial contraction into a hypertrophied left
ventricle
Systolic murmur: The classic crescendo-decrescendo systolic murmur of aortic
stenosis begins shortly after the first heart sound; the intensity increases toward
mid systole and then decreases, with the murmur ending just before the second
heart sound
In infants : poor feeding, rapid breathing, clammy sweating, lethargy, and/or
irritability.
DIAGNOSIS

Physical findings:Aortic stenosis is often diagnosed

due to the presence of a heart murmur
Prenatal diagnosis: Fetal diagnosis of aortic stenosis
is made by an echocardiogram of the baby's heart and
can be made as early as 16 weeks into the pregnancy
In neonates, pulse oximetry
The evaluation for sepsis in infants presenting with
shock includes blood, urine, and cerebrospinal fluid
(CSF) cultures.
CONT..

Chest x-ray
Doppler echocardiography
ECG
Exercise stress testing
Left cardiac catheterization
MRI of the heart
CONT..
Cont..

Exercise stress testing can usually be performed in children aged

6 years or older with aortic stenosis
Doppler studies can be helpful in determining whether exercise
restrictions are necessary by measuring the change in aortic
valve gradient
Cardiac catheterization is usually performed in infants, children,
and older adolescents with aortic stenosis in anticipation of
balloon aortic valvuloplasty and to know the left ventricular
filling pressures and for accurate hemodynamic assessment
TREATMENT

prostaglandin E1at a dose of 0.01-0.1 mcg/kg/min.

Establishing patency of the ductus arteriosus.
Medications are used to treat symptoms of heart failure
or abnormal heart rhythms
diuretics (water pills), nitrates, and beta-blockers
Inotropic drugs, such as dopamine, dobutamine, and
epinephrine, may be indicated in cases of reduced
cardiac output in the presence of decreased left
ventricular systolic function.
CONT.

Balloon aortic valvuloplasty

surgical aortic valvotomy
Surgical Aortic Valve Replacement
mechanical prosthetic valve,
bioprosthetic valve,
Ross procedure
Mechanical & bioprosthetic valves
PROGNOSIS

Without surgery, a person with aortic stenosis

who hasangina, fainting (syncope),or signs of
heart failure will usually do poorly.
Aortic stenosis can be cured with surgery. After
surgery there is a risk for irregular heart
rhythms, which can cause sudden death, and
blood clots, which can cause a stroke.
COMPLICATIONS

Angina (chest pain)

Arrhythmias
Endocarditis
Fainting (syncope)
Left-sided heart failure
Left ventricular hypertrophy (heart wall thickening)
caused by the extra work of pushing blood through the
narrowed valve