Aortic Stenosis

It is the most common of all valvular abnormalities. Normal aortic valve area = 3-4 cm2

• Mild AS - valve area 1.5 to 3 cm²
• Moderate AS - valve area 1.0 to 1.5 cm²
• Severe AS - valve area < 1.0 cm²
• Critical AS - valve area < 0.5 cm

Clinical presentation

Aortic Stenosis clinically present with symptoms Of angina (most common) , syncope , CHF ( most serious ) , hemolytic anemia and sudden death.

On examination

There is Slow - rising pulse with narrow pulse pressure and crescendo decrescendo ejection systolic murmur at right 2nd inter - costal space. The murmur radiates to carotids, is increased with passive leg raise (increased pre - load) and decrease with standing and Valsalva (decreased pre - load)

Investigations

• ECG: P - mitral, LVH with strain pattern; LAD (left anterior hemi block), LBBB or complete AV block.
• CXR: LVH; calcified aortic valve, Post - stenotic dilatation of ascending aorta.
• Echocardiography: Doppler echo can estimate the gradient across valves. Severe stenosis if peak gradient 2 50mmHg and valve area < 1cm².

Management

• Asymptomatic patients with severe aortic stenosis (aortic valve area less than 1.0 cm ' ) should generally undergo intervention according to the following guidelines
• They are undergoing other cardiac surgery (i.e., CABG),
• There is evidence for a reduced LVEF (less than 50 %)
• When there are severe valvular calcium
• Symptomatic patients - Valve replacement
• If patient not fit for surgery Percutaneous valve replacement.