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

2. Anatomy

3. Laplace’s Law WT=PXR/2h
Pathophysiology
Laplace’s Law WT=PXR/2h

5. Aortic stenosis
Dejenerative
Bicuspid
Rheumatic

6. 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)

7. Signs systolic ejection crescendo-decrescendo murmur
Pulsus parvus et tardus

9. Echo

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

13. Surgical indications

17. 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 .

18. 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.

22. 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.

23. Signs Table 22.2 Signs of aortic insufficiency Sign Finding
Corrigan’s pulse
Rapid forceful carotid upstroke followed by rapid decline
Quincke’s pulse
Systolic plethora and diastolic blanching in nail bed when nail is slightly compressed
de Musset’s sign
Bobbing of head
Duroziez’s sign
Systolic and diastolic bruit heard over femoral artery when compressed by bell of stethoscope
Hill’s sign
Augmentation of systolic blood pressure in leg by ³30 mm Hg compared with that in arm

24. Diastolic murmur
Austin Flint murmur, middiastolic apical murmur

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