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Aortic Stenosis

•  5-7% of CHD •  M:F = 4:1 •  Valvular, supra- or

sub-valvular, HCM •  1,2 or 3 cusps to AV

Aortic stenosis

AS- Clinical

•  There may be no symptoms in even severe AS until sudden collapse during exercise

•  Symptoms – chest pain, tiredness or syncope in some severe cases

•  Critical AS in NB and infancy -> CCF or death

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AS examination

•  Mild cases may have only an ejection SM at UR or LSE to neck and ejection click

•  More significant AS -> decreased BP and pulse volume. Severe AS -> paradoxical splitting of S2. Apex beat forceful

•  Critical AS in infancy have large heart and CCF

AS - Investigations

•  ECG Normal in mild cases. LVH +/- strain in more severe cases

•  Cxray – heart size normal (concentric hypertrophy)

•  2Decho shows defect, abnormal flow, gradient

AS – Treatment

•  Medical – Dental hygiene. IE prophylaxis. Careful follow-up and repeat investigations

•  EXERCISE RESTRICTION FOR MODERATE & SEVERE CASES

•  Balloon valvuloplasty •  Surgery: Valvotomy, commisurotomy,

valve replacement . Follow-up post-op •  Medical - for HCM with beta-blockers

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Pulmonary stenosis

•  5-7% CHD •  Valvular, supra- or

sub-valvular

PS - Clinical

•  Mild – asymptomatic •  Moderate – severe may have SOB on

exertion •  Critical PS may have cyanosis, SOB, CCF •  RV type AB. Soft, delayed or absent P2 •  Ejection click. ESM at ULSE -> back

PS - Investigations

•  ECG Normal in mild cases. RVH, RAD. •  Cxray Heart size usually normal, Post

stenotic dilatation in valvular PS. •  Decreased pulm vascular markings •  2Decho – thick doming PV or narrowed

area. Abnormal flow.

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PS - Treatment

•  Exercise restricted in severe PS •  Medical- IE prophylaxis •  Balloon valvuloplasty preferably. •  Surgery – valvotomy, resection of thick

muscle at infundibulum, patching of RVOT •  Post-op follow-up and 2DE

Balloon valvuloplasty