*Aortic Stenosis is the narrowing of the aortic valve orifice or opening *Read pages 26 – 35 in The Echocardiographer’s Pocket Reference; Read pages 259 – 276 in Otto; Read pages 179 – 184 in Echo Review

*Etiology/Causes of AS:  Degenerative or senile(most common cause)  Congenital(Bicuspid AV, with this also look for a coarct)  Rheumatic fever *Signs and Symptoms:  Dyspnea on exertion(most common presenting symptom)  Congestive heart failure(2 nd most common)  Angina pectoris(chest pain due to ischemia)  Effort syncope(syncope while active)

Rheumatic and Calcified Valves Calcific Tricuspid Valve Calcific Bicuspid Valve Rheumatic Valve

*Physical Examination:  Low systolic blood pressure(may indicate significant stenosis)  Pulsus parvus et tardus(small and late rising carotid pulse)  Systolic thrill palpable at the aortic area  Pulsus alternans(alternating strong and weak beats(indicates severe LV failure) *Complications:  Results in LV pressure overload and LVH  Increased LV end-diastolic pressure  Increased LA pressure

Harsh, systolic ejection murmur, crescendo-decrescendo in shape, that is best heard at the right upper sternal border and may radiate into the carotid arteries!

*Pressures in the LA and LV will increase with AS, because of the restriction of blood flow to the body, which causes a backup of blood in the LV/LA. Transversely, the pressures in the AO will decrease, because of the decrease of flow getting through the AV.

*Activity should be limited in patients with significant AS *Surgical treatment is usually the preferred treatment in severe cases -Aortic valve replacement(AVR) -Ross procedure(pulmonic valve transplantation to the aortic valve position, reimplantation of the coronary arteries and placement a homograft in the pulmonary position) -Aortic balloon valvuloplasty(not very successful with adults)

Normal AV waveform AS waveform(AI is also noted)

*To figure the Max Press Grad from this image……it’s very simple! Use the formula 4(V) squared! This velocity is at or around 4 m/s, so we will use 4 for easiness sake. 4(4) squared = 4(16) = 64mmHg So the Max Press Grad is 64mmHg

*AVA is another very important measurement with AS. AVA =.785 x LVOTd squared x LVOT VTI/ AV VTI Ex..785 x (2.0) squared x 20/25 = AVA.785 x 4 x 20/25 = 2.5 cm squared is the AVA

Peak AV Velocity Mild< 3.0 m/s Moderate3.0 to 4.0 m/s Severe> 4.0 m/s Maximum(Peak) Instantaneous Pressure Gradient Mild16 to 36 mmHg Moderate36 to 50 mmHg Mod/Sev50 to 64 mmHg Severe> 64 mmHg Mean Transvalvular Pressure Gradient Mild< 30 mmHg Moderate30 to 50 mmHg Severe> 50 mmHg Aortic Valve Area(AVA) Normal3.0 to 5.0 cm squared Mild> 1.5 cm squared Moderate1.1 to 1.5 cm squared Severe< 1.0 cm squared