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Aortic stenosis: Difference between revisions
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Because of the reducing compliance of the left ventricle, the ventricle is more dependent on the left atrial contraction for filling than in a healthy heart. If atrial fibrillation should occur, this atrial contraction is lost, worsening the patients symptoms. | Because of the reducing compliance of the left ventricle, the ventricle is more dependent on the left atrial contraction for filling than in a healthy heart. If atrial fibrillation should occur, this atrial contraction is lost, worsening the patients symptoms. | ||
Marked left ventricular hypertrophy may compress the coronary vasculature in diastole, potentially inducing ischaemia even in the absence of coronary artery disease. This causes the characteristic angina. | |||
Syncope may occur because the left ventricle cannot generate enough pressure to increase the minute volume when the peripheral vasculature resistance increases, for example during exercise. | |||
== Clinical features == | == Clinical features == | ||
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[[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. It can also detect whether the aortic valve is bicuspid or tricuspid. [[Coronary angiography]] can be used to assess the degree of [[coronary artery disease]], which is useful as pre-operative assessment if surgical treatment is considered. | [[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. It can also detect whether the aortic valve is bicuspid or tricuspid. [[Coronary angiography]] can be used to assess the degree of [[coronary artery disease]], which is useful as pre-operative assessment if surgical treatment is considered. | ||
A [[Chest radiography|chest radiograph]] may show enlarged left border of the heart and dilation of the ascending aorta. | A [[Chest radiography|chest radiograph]] may show enlarged left border of the heart and dilation of the ascending aorta. ECG-gated CT of the heart is obligatory pre-operative assessment for valve replacement.<section end="radiology" /> | ||
<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. | ||
Endovascular replacement (TAVR) is usually recommended to those with unacceptable surgical risk, as there isn't as much documentation on the long-term results of TAVR compared to surgical replacement (SAVR). The latter is recommended to those who are younger and less comorbid. | |||
Antihypertensive treatment, preferably with RAAS inhibitor, is recommended to reduce the afterload of the left ventricle and to prevent ventricular remodelling. | |||
== Complications == | == Complications == | ||