(Peri-Op & Anaesthesia) (Surgery)

Overview

• Aortic Stenosis → narrowing of the aortic valve, hence the outflow of blood from the left ventricle into the aorta is obstructed

Aetiology:

• Aortic Valve Sclerosis (>50%) → calcification and fibrosis of aortic valve leaflets. Most common cause of aortic stenosis in patients >65 years.
• Bicuspid Aortic Valve (>30%) → fusion of two of the three aortic-valve leaflets in utero. Most common cause in younger patients <65 years.
• Rheumatic Fever (<10%) → rare cause due to consistant use of antibiotics in treatment of streptocococcal pharyngitis

• Aortic Regurgitation → incomplete closure of the aortic valve, leading to the reflux of blood from the aorta into the left ventricle during diastole
• Acute → infective endocarditis or aortic dissection (ascending aorta)
• Chronic → congenital bicuspid aortic valve, rheumatic heart disease, aortic dilatation (due to connective tissue disorders)

Making Diagnosis

Clinical Features:

• Aortic Stenosis → exertional dyspnoea, angina, dizziness, syncope. ****(SAD = syncope (exertional), angina, dyspnoea)
• Narrowing PP, slow rising pulse, soft S2
• AS Auscultation → harsh crescendo-decrescendo (diamond-shaped), late ejection systolic murmur that radiates bilaterally to the carotids