Degenerative aortic stenosisRadhakrishnan Ramaraj and Vincent L Sorrell.pptVIP

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Degenerative aortic stenosisRadhakrishnan Ramaraj and Vincent L Sorrell.ppt

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Degenerative aortic stenosisRadhakrishnan Ramaraj and Vincent L Sorrell

Degenerative aortic stenosisRadhakrishnan Ramaraj and Vincent L SorrellBMJ 2008;336;550-555 (clinical review) 中國醫藥大學附設醫院麻醉部 R3 廖承駿 / VS 黃家樂 Introduction calcific aortic stenosis in 2-7% of the population aged 65 years About 80% of adult patients with symptomatic aortic stenosis are male By 2020, about 3.5 million people in England are expected to have aortic sclerosis and 150 000 will have severe aortic stenosis provide an overview to help diagnosis and a summary of the management of AS and its sequelae What are the factors leading to aortic stenosis? calcification of a normal trileaflet Calcific aortic stenosis is thought to be a degenerative process that shares many features with coronary artery disease, such as lipid accumulation, inflammation, and calcification What are the factors leading to aortic stenosis? abnormal architecture of the bicuspid or unicuspid aortic valve: susceptible to haemodynamic stress, leading to valvular thickening, calcification, and increased rigidity and narrowing of the aortic orifice coronary artery disease Rheumatic inflammation of the valve leaflets How is the haemodynamic severity of aortic stenosis classified? How do we diagnose aortic stenosis? Clinical diagnosis: Clinical diagnosis: (history and physical examination) exertional shortness of breath, angina, dizziness, or syncope. systolic murmur, a late peaking murmur has a more severe degree of stenosis Radiological diagnosis: (Echocardiography) presence of aortic stenosis, degree of valve calcification, left ventricular function, wall thickness. valve area 1.0 cm2 is considered severe, cut-off value of 0.6 cm2/m2 BSA What is the natural course of aortic stenosis? left ventricular hypertrophy → raises myocardial oxygen consumption, direct ventricular pressure compressing the coronary arteries during diastolic flow → cause myocardial ischemia and angina → LV diastolic and systolic dysfunction → CHF After the onset of symptoms, the average survival is only two to three year