Aortic Stenosis

Slightly narrowed, thickened, or roughened valves (aortic sclerosis) or aortic dilation may produce the typical murmur and thrill without causing significant hemodynamic effects. In mild or moderate cases, the characteristic signs are a systolic ejection murmur at the aortic area transmitted to the neck and apex; in severe cases, a palpable left ventricular heave or thrill, a weak to absent aortic second sound, or reversed splitting of the second sound is present. When the valve area is less than 0.8–1 cm2 (normal, 3–4 cm2), ventricular systole becomes prolonged and the typical carotid pulse pattern of delayed upstroke and low amplitude is present, but this may be an unreliable finding in older patients with extensive arteriosclerotic vascular disease. Left ventricular hypertrophy increases progressively, with resulting elevations in ventricular end-diastolic pressure. Cardiac output is maintained until the stenosis is severe (with a valve area < 0.8 cm2). Patients may present with left ventricular failure, angina pectoris, or syncope.

Aortic Stenosis is due to the decreasing amounts of water will pass through the obstruction. Pressure behind the nozzle will build up. Aortic Stenosis nothing is done, your lawn will not get the water it needs. Aortic Stenosis is a Cardiovascular disease occuring at the level of the aortic valve in 60-75% of cases. Aortic valve stenosis (AS) is a heart condition caused by the incomplete opening of the aortic valve. The heart muscle can be damaged when it does not receive enough blood. A damaged heart cannot pump enough blood for the body's needs, leading to heart failure. It is associated with a bicuspid aortic valve in greater than 50% of cases.

Causes of Aortic Stenosis

Some common causes follows:

• The most common cause is a birth defect, such as a valve with only two cusps instead of the usual three or a valve with an abnormal funnel shape
• Newborns with significant AS develop CHF within the first week of life. The left ventricle is often too small to be compatible with life. The newborn heart develops left-to-right shunting through the patent foramen ovale, which leads to worsening CHF.
• Calcific AS also occurs in older patients with congenital or acquired bicuspid valves. Congenital bicuspid valves cause calcific AS 4 times more frequently than acquired forms do.
• The aortic valve becomes more narrow, the pressure increases inside the left heart ventricle. This causes the left heart ventricle to become thicker, which decreases blood flow and can lead to chest pain. As the pressure continues to increase, blood may back up into the lungs and you may feel short of breath
• Other cause of aortic stenosis in patients 65 years and over is called "senile calcific aortic stenosis." With aging, protein collagen of the valve leaflets is destroyed, and calcium is deposited on the leaflets
• Progressive wear and tear of a bicuspid valve present since birth (congenital).

Symptoms of Aortic Stenosis

These are symptoms of Aortic Stenosis :

• Fainting , weakness , or dizziness with activity
• Breathlessness with activity
• Sensation of feeling the heart beat ( palpitations )
• People who have severe aortic stenosis may faint during exertion because blood pressure may fall suddenly .
• The damaged aortic valve can become infected by bacteria, resulting in infective endocarditis

Prognosis & Treatment of of Aortic Stenosis

Following the onset of heart failure, angina, or syncope, the prognosis without surgery is poor (50% 3-year mortality rate). Medical treatment may stabilize patients in heart failure, but surgery is indicated for all symptomatic patients, including those with left ventricular dysfunction, which often improves postoperatively. Valve replacement is usually not indicated in asymptomatic individuals. Exceptions are those with declining left ventricular function, very severe left ventricular hypertrophy, and very high gradients (> 80 mm Hg) or severely reduced valve areas ( 0.7 cm2).

The surgical mortality rate for valve replacement is 2–5%, but it rises to 10% above the age of 75. Mortality rates are substantially higher when left ventricular function is depressed or when severe coronary disease and prior myocardial infarctions are present. Severe coronary lesions are usually bypassed at the same time. Anticoagulation with warfarin is required for mechanical prostheses but is not essential with bioprostheses. Although bioprosthetic valves have hitherto undergone degenerative changes and required replacement within 7–10 years (sometimes within 3 years), newer ones may be more durable. Some centers have begun performing the Ross procedure, which entails switching the patient's pulmonary valve to the aortic position and placing a bioprosthesis in the pulmonary position. Because bioprostheses do not deteriorate as fast on the right side of the heart, this procedure has produced excellent long-term results without anticoagulation.

Although percutaneous balloon valvuloplasty can produce short-term reductions in the severity of aortic stenosis, restenosis occurs rapidly in most adults who have calcified valves. Except in adolescents, balloon valvuloplasty should be reserved for individuals who are poor candidates for surgery or as an intermediate procedure to stabilize high-risk patients prior to surgery. Some treatment methods for Aortic Stenosis

• Aortic Stenosis is important to note that aortic stenosis may be progressive, and that children with mild disease may eventually require treatment later in life.
• Adults who have aortic stenosis but no symptoms should see their doctor regularly and should avoid overly stressful exercise.
• Medications can include diuretics, digoxin, and other medications to control heart failure People with symptoms of aortic stenosis should have a physical exam every 6 to 12 months and an ECG performed every 1 to 3 years.
• For children who have severe stenosis, surgery may be performed even before symptoms develop, because sudden death may occur before symptoms develop.
• Safe, effective alternatives to valve replacement are surgical repair of the valve and balloon valvuloplasty.

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