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Aortic stenosis: Difference between revisions
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'''Aortic stenosis''' (AS) refers to narrowing of the aortic valve, resulting in increased pressure load on the left ventricle. AS is mostly a disorder of the elderly (>70 years) men, and it’s the most common [[Valvular heart disease|valvular disease]]. Some also have some degree of [[aortic regurgitation]]. | <section begin="radiology" />'''Aortic stenosis''' (AS) refers to narrowing of the aortic valve, resulting in increased pressure load on the left ventricle. AS is mostly a disorder of the elderly (>70 years) men, and it’s the most common [[Valvular heart disease|valvular disease]]. Some also have some degree of [[aortic regurgitation]].<section end="radiology" /> | ||
== Etiology == | == Etiology == | ||
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A systolic crescendo-decrescendo ejection murmur is typical. It’s best heard at the punctum maximum of the aortic valve, parasternally in the 2nd right intercostal space. It may radiate to the carotids. Soft S2 is also a typical finding. | A systolic crescendo-decrescendo ejection murmur is typical. It’s best heard at the punctum maximum of the aortic valve, parasternally in the 2nd right intercostal space. It may radiate to the carotids. Soft S2 is also a typical finding. | ||
<section begin="radiology" /> | |||
== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
[[Echocardiography]] allows for assessment of the aortic valve opening area and the pressure gradient and velocity across the valve, which is increased in case of stenosis. [[Coronary angiography]] can be used to assess the degree of [[coronary artery disease]]. | [[Echocardiography]] allows for assessment of the narrowing of the aortic valve opening area and the pressure gradient and velocity across the valve, which is increased in case of stenosis. [[Coronary angiography]] can be used to assess the degree of [[coronary artery disease]]. | ||
A chest radiograph may show enlarged left border of the heart and dilation of the ascending aorta. | |||
<section end="radiology" /> | |||
== Treatment == | == Treatment == | ||
In mild cases, regular follow-up alone might be sufficient, but the only definitive treatment is valvular replacement. This can be achieved by open surgery (surgical aortic valve replacement, SAVR) or transcatheter replacement (transcatheter aortic valve replacement, TAVR). If significant [[Coronary artery disease|CAD]] is present, [[coronary bypass]] can be performed in the same setting as the surgical replacement of the valve. | In mild cases, regular follow-up alone might be sufficient, but the only definitive treatment is valvular replacement. This can be achieved by open surgery (surgical aortic valve replacement, SAVR) or transcatheter replacement (transcatheter aortic valve replacement, TAVR). If significant [[Coronary artery disease|CAD]] is present, [[coronary bypass]] can be performed in the same setting as the surgical replacement of the valve. | ||