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Common Congenital Heart Lesions - page 14 / 126

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Diagnostic imaging/testing:

  • Electrocardiogram:

    • o

      LV hypertrophy is common in advanced AS.

oWith AS, get increased QRS voltage, get inverted T waves and get ST depression (due to pressure overload).

  • Echocardiography:

    • o

      Sensitive way to assess LV wall thickness.

oTrans-valvular pressure gradient and aortic valve area can be calculated by Doppler echocardiography.

  • Cardiac Catheterization:

    • o

      Sometimes used to confirm the severity of AS and also to define the coronary anatomy, because concurrent coronary artery bypass surgery is often necessary at the time of aortic valve replacement in patients who have coronary disease in addition to their AS.

Treatment:

  • Natural history of severe, symptomatic, uncorrected AS is very poor. (One year survival rate for patients with severe AS who don’t undergo surgery is 57%.)

  • Only effective treatment for advanced AS is surgical replacement of the valve.

  • Aortic Valve Replacement (AVR): indicated for AS when: 1/ patients with severe LV outflow obstruction develop symptoms or 2/ there’s evidence of progressive LV dysfunction in the absence of symptoms.

  • After AVR, LV ejection fraction almost always increases.

  • AVR gives a 10 year survival rate that exceeds 75%!

  • Percutaneous valvuloplasty: unlike in MS, where it works pretty well, it doesn’t work well in AS oBalloon dilatation across the aortic valve orifice can fracture fused, calcified valve commissures providing some immediate outflow obstruction relief…BUT 50% of AS patients then undergo valve RE-stenosis within 6 months.

oValvuloplasty in AS patients is only used for patients who are poor surgical candidates or as a temporary fix in patients who are too sick to go directly into AVR surgery.

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