Aortic Valve Disease Soner Sanioğlu, M.D. Assoc. Prof. of Cardivascular Surgery

Anatomy

Pathophysiology Laplace’s Law WT=PXR/2h

Aortic stenosis Dejenerative Bicuspid Rheumatic

Symptoms Angina pectoris: CPP=DAP-EDLVP (survival 5 y) Syncope: exercise→ fixed CO→ reduced cerebral perfusion (survival 3 y) Dyspnea and heart failure: (survival 2 y)

Signs systolic ejection crescendo-decrescendo murmur Pulsus parvus et tardus

Echo

Medical treatment ß- blocer, HR↓ ejection time ↑ Diuretic, pulmonary congestion ↓

Surgical indications

Aortic Regurgitation Calcific aortic disease, Idiopathic degenerative disease, Active or chronic aortic valve endocarditis, Rheumatic disease Biscuspid aortic valve, Myxomatous proliferation of aortic valve tissue Anorectic medications, such as fenfluramine and phentermine, Carcinoid syndrome. Aortic annular dilatation: aortic dissection; trauma; chronic systemic hypertension; aortitis from syphilis, viral syndromes, or other systemic arteritides (e.g., giant cell and Takayasu); and connective tissue disorders such as Marfan syndrome, Reiter disease, Ehlers- Danlos syndrome, osteogenesis imperfecta, and rheumatoid arthritis.

Pure AR is rare and is seen commonly only in aortic dissection or annular dilatation. Most commonly, aortic valvular insufficiency is seen in combination with AS, e.g. rheumatic valvular disease, or myxomatous degenerative disease.

Symptoms Asymptomatic for prolonged periods of time Palpitations Chest pain Most symptoms of AR occur from underlying heart failure and pulmonary congestion Dyspnea and PND, CHF.

Signs Table 22.2 Signs of aortic insufficiency SignFinding Corrigan’s pulseRapid forceful carotid upstroke followed by rapid decline Quincke’s pulseSystolic plethora and diastolic blanching in nail bed when nail is slightly compressed de Musset’s signBobbing of head Duroziez’s signSystolic and diastolic bruit heard over femoral artery when compressed by bell of stethoscope Hill’s sign Augmentation of systolic blood pressure in leg by  30 mm Hg compared with that in arm

Diastolic murmur Austin Flint murmur, middiastolic apical murmur

Medical treatment Vasodilator theraphy, SVR↓ Diuretic, pulmonary congestion ↓