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Common Congenital Heart Lesions - page 6 / 126





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4. Congenital Aortic Stenosis

Clinical Presentation: usually asymptomatic. 10% of infants have symptoms of heart failure (won’t eat, breathin’ too fast, heart beatin’ too fast, and failure to thrive). In adults, symptoms include fatigue, exertional dyspnea, angina pectoris, and syncope.

Physical Findings:

  • 1.

    Harsh crescendo-descrendo systolic murmur heard loudest at base of heart and radiating to the neck

  • 2.

    murmur preceded by Systolic Ejection Click

  • 3.

    ***Murmur is present from birth and is not dependent on decline in pulm vascular resistance (unlike ASD, VSD, and PDA)

  • 4.

    Increased ejection time, peak of murmur occurs late in systole

  • 5.

    Reverse splitting of S2 in severe cases (A2 closes after P2)

Diagnostic Imaging and Testing:

  • A.

    Chest x-ray: enlarged LV, dilated ascending aorta

  • B.

    ECG: LVH

  • C.

    Echo: identify structure of aortic valve and degree of LVH, Doppler is used to estimate the pressure gradient across the aortic valve and the size of the opening

  • D.

    Cardiac Cath: used to confirm pressure gradient across the valve

Treatment: Endocarditid prophylaxis for all cases, mild forms do not require treatment, severe obstruction is repaired by balloon angioplasty or surgery

Etiology: abnormal development of aortic valve resulting in BICUSPID leaflets and an eccentric, stenotic opening

Pathology: LVH and dilated aorta

Pathophysiology: Increase in left ventricular systolic pressure in order to pump blood across the narrowed valve opening. Increase in pressure causes LVH. Also, blood travels over valve and hits the aorta with increased speed, causing trauma to the aorta and resulting in dilation of the aortic wall.

Epidemiology: 4x more common in males than females, 20% have other abnormalities, usually coarctation of aorta, occurs in 2% of population, but only rarely causes congenital AS

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