Reading time: 8 minutes. Views 2.6k.
Aortic stenosis is a pathological condition in which a narrowing of the opening occurs in the valve of the same name. For this reason, there is a disturbance in the outflow of blood from the left ventricle. It falls under the category of heart defects.
From the left ventricle, blood penetrates through the aorta to the main organ systems. This is a large circle of blood circulation. Its weak link is the aortic valve at the mouth of the vessel. It has 3 doors and opens to let in vascular system a portion of biological fluid. Each time the ventricle contracts, it pushes it out. When closing, the valve acts as an obstacle to the return of blood. This is where pathological changes occur.
In case of stenosis, the soft tissues of the valves and aorta undergo various changes. These may be scars or adhesions, deposits of calcium salts, atherosclerotic plaques or fusion. As a result, the following violations are observed:
Against the background of these changes, insufficient blood supply to the main organ systems occurs.
Aortic stenosis has a congenital or acquired etiology. In the first case, the occurrence of an anomaly is due to a genetic predisposition or pathological abnormalities during fetal development. Normally, the valve has 3 leaflets. In the congenital form of stenosis, this element consists of 2 or 1 leaf.
How often do you get your blood tested?
Poll Options are limited because JavaScript is disabled in your browser.
Only as prescribed by the attending physician 31%, 1718 votes
Once a year and I think that’s enough 17%, 954 vote
At least twice a year 15%, 831 voice
More than twice a year but less than six times 11%, 629 votes
I take care of my health and donate once a month 6%, 339 votes
I'm afraid of this procedure and try not to pass 4%, 235 votes
21.10.2019
However, most often, narrowing of the aorta is an acquired defect. The following health problems may be the cause:
Doctors identify a number of factors, the presence of which increases the risk of pathology. These include smoking and hypertension.
Depending on the location, aortic stenosis can be:
To assess the severity of aortic stenosis, classification involves pressure gradient results. That's the difference blood pressure before and after the aortic valve. U healthy person this indicator minimal. The stronger the narrowing, the higher the pressure. For example, with grade I stenosis, the gradient ranges from 10 to 35 mm Hg. Art. IV degree is considered critical. In this case, the pressure gradient is more than 80 mmHg. Art.
In addition, there are several stages of development pathological process. Each of them has a characteristic clinical picture, helping to establish an accurate diagnosis:
In aortic stenosis, symptoms do not become noticeable for several decades. On initial stages when the lumen of the vessel closes by 50% or more, it manifests itself as weakness after exercise.
As the disease progresses, shortness of breath persists after moderate exertion. It is almost always accompanied by general fatigue and dizziness. When the lumen of the vessel closes by 75% or more, the patient develops the main signs of heart failure.
The pathology is also manifested by the following symptoms:
Stenosis may cause sudden death no visible external manifestations.
In newborns and preschool children, the disease is often asymptomatic. As they grow, the clinical picture becomes more pronounced due to the increase in heart size. However, the narrow lumen in the aortic valve remains unchanged.
Pathology in the fetus can be diagnosed as early as 6 months of pregnancy using echocardiography. In rare cases, stenosis appears immediately after the baby is born. In 30% of cases, the condition suddenly worsens by 5-6 months. Among the main symptoms of the disorder in newborns, doctors identify the following:
Aortic stenosis or stenosis of the aortic ostium is characterized by a narrowing of the outflow tract in the area of the semilunar valve of the aorta, which makes systolic emptying of the left ventricle difficult and the pressure gradient between its chamber and the aorta sharply increases.
The share of aortic stenosis in the structure of other heart defects is 20–25%. Aortic stenosis is 3–4 times more common in men than in women.
Isolated aortic stenosis is rare in cardiology - in 1.5-2% of cases; in most cases this defect is combined with others valve defects– mitral stenosis, aortic insufficiency, etc.
By origin, congenital (3-5.5%) and acquired stenosis of the aortic mouth are distinguished. Taking into account the localization of the pathological narrowing, aortic stenosis can be subvalvular (25-30%), supravalvular (6-10%) and valvular (about 60%).
The severity of aortic stenosis is determined by the systolic pressure gradient between the aorta and the left ventricle, as well as the area of the valve opening.
With minor aortic stenosis of the first degree, the opening area is from 1.6 to 1.2 cm² (with the norm being 2.5-3.5 cm²); The systolic pressure gradient is in the range of 10–35 mmHg. Art. Moderate aortic stenosis of degree II is indicated when the valve opening area is from 1.2 to 0.75 cm² and the pressure gradient is 36–65 mm Hg.
Art. Severe grade III aortic stenosis is noted when the area of the valve opening is narrowed to less than 0.74 cm² and the pressure gradient increases to more than 65 mm Hg. Art.
Depending on the degree of hemodynamic disturbances, aortic stenosis can occur as compensated or decompensated (critical) clinical variant, in connection with which 5 stages are distinguished.
Stage I(full compensation). Aortic stenosis can only be detected by auscultation; the degree of narrowing of the aortic orifice is insignificant. Patients require dynamic monitoring by a cardiologist; surgical treatment not shown.
Stage II(latent heart failure). There are complaints of fatigue, shortness of breath with moderate physical activity, and dizziness. Signs of aortic stenosis are determined by ECG data and radiography, pressure gradient in the range of 36–65 mm Hg. Art., which serves as an indication for surgical correction of the defect.
Stage III(relative coronary insufficiency). Typically increased shortness of breath, angina, and fainting. The systolic pressure gradient exceeds 65 mmHg. Art. Surgical treatment of aortic stenosis at this stage is possible and necessary.
IV stage(severe heart failure). Worried about shortness of breath at rest, nocturnal attacks of cardiac asthma. Surgical correction of the defect is already excluded in most cases; in some patients cardiac surgery treatment potentially possible, but with less effect.
Stage V(terminal). Heart failure is steadily progressing, shortness of breath and edema syndrome are pronounced. Drug treatment achieves only short-term improvement; Surgical correction of aortic stenosis is contraindicated.
Acquired aortic stenosis is most often caused by rheumatic damage to the valve leaflets. In this case, the valve flaps are deformed, fuse together, become dense and rigid, leading to a narrowing of the valve ring.
Causes of acquired aortic stenosis can also include atherosclerosis of the aorta, calcification (calcification) of the aortic valve, infective endocarditis, Paget's disease, systemic lupus erythematosus, rheumatoid arthritis, and end-stage renal failure.
Congenital aortic stenosis occurs when congenital narrowing aortic orifice or developmental anomalies - bicuspid aortic valve. Congenital aortic valve disease usually appears before age 30; acquired - at an older age (usually after 60 years). Smoking, hypercholesterolemia, and arterial hypertension accelerate the formation of aortic stenosis.
With aortic stenosis, severe disturbances of intracardiac and then general hemodynamics develop. This is due to difficulty emptying the cavity of the left ventricle, due to which there is a significant increase in the systolic pressure gradient between the left ventricle and the aorta, which can reach from 20 to 100 or more mm Hg. Art.
The functioning of the left ventricle under conditions of increased load is accompanied by its hypertrophy, the degree of which, in turn, depends on the severity of the narrowing of the aortic opening and the duration of the defect. Compensatory hypertrophy ensures long-term preservation of normal cardiac output, which inhibits the development of cardiac decompensation.
However, with aortic stenosis, a violation of coronary perfusion occurs quite early, associated with an increase in end-diastolic pressure in the left ventricle and compression of the subendocardial vessels by the hypertrophied myocardium. That is why in patients with aortic stenosis, signs of coronary insufficiency appear long before the onset of cardiac decompensation.
As you decrease contractility hypertrophied left ventricle, stroke volume and ejection fraction decrease, which is accompanied by myogenic left ventricular dilation, increased end-diastolic pressure and the development of left ventricular systolic dysfunction.
Against this background, the pressure in the left atrium and pulmonary circulation increases, i.e., arterial pulmonary hypertension develops. In this case, the clinical picture of aortic stenosis may be aggravated by relative insufficiency mitral valve(“mitralization” of aortic disease).
High system pressure pulmonary artery naturally leads to compensatory hypertrophy of the right ventricle, and then to total heart failure.
At the stage of complete compensation of aortic stenosis, patients do not feel noticeable discomfort for a long time. The first manifestations are associated with a narrowing of the aortic mouth to approximately 50% of its lumen and are characterized by shortness of breath during exercise, fatigue, muscle weakness, and a feeling of palpitations.
At the stage of coronary insufficiency, dizziness and fainting occur when quick shift body position, angina attacks, paroxysmal (night) shortness of breath, in severe cases - attacks of cardiac asthma and pulmonary edema. The combination of angina pectoris with syncope, and especially the addition of cardiac asthma, is unfavorable prognostically.
With the development of right ventricular failure, swelling and a feeling of heaviness in the right hypochondrium are noted.
Sudden cardiac death with aortic stenosis occurs in 5–10% of cases, mainly in elderly people with severe narrowing of the valve opening.
Complications of aortic stenosis may include infective endocarditis, ischemic cerebrovascular accidents, arrhythmias, AV block, myocardial infarction, gastrointestinal bleeding from lower sections digestive tract.
The appearance of a patient with aortic stenosis is characterized by pallor of the skin (“aortic pallor”), due to a tendency to peripheral vasoconstrictor reactions; in later stages, acrocyanosis may occur. Peripheral edema is detected in severe aortic stenosis. Upon percussion, the expansion of the borders of the heart to the left and down is determined; The displacement of the apical impulse and systolic tremor in the jugular fossa are palpably felt.
Auscultatory signs of aortic stenosis are rough systolic murmur above the aorta and above the mitral valve, muffled sounds of the first and second sounds in the aorta. These changes are also recorded during phonocardiography. According to the ECG, signs of left ventricular hypertrophy, arrhythmia, and sometimes blockade are determined.
During the period of decompensation, radiographs reveal an expansion of the shadow of the left ventricle in the form of lengthening of the arc of the left contour of the heart, a characteristic aortic configuration of the heart, poststenotic dilatation of the aorta, and signs of pulmonary hypertension. Echocardiography reveals thickening of the aortic valve flaps, limitation of the amplitude of movement of the valve leaflets in systole, and hypertrophy of the walls of the left ventricle.
In order to measure the pressure gradient between the left ventricle and the aorta, probing of the heart cavities is performed, which makes it possible to indirectly judge the degree of aortic stenosis.
Ventriculography is necessary to identify concomitant mitral regurgitation.
Aortography and coronary angiography are used for differential diagnosis aortic stenosis with aneurysm of the ascending aorta and ischemic heart disease.
All patients, incl. with asymptomatic, fully compensated aortic stenosis should be closely monitored by a cardiologist. They are recommended to undergo echocardiography every 6-12 months.
In order to prevent infective endocarditis, this group of patients requires preventive antibiotics before dental (treatment of caries, tooth extraction, etc.) and other invasive procedures. Management of pregnancy in women with aortic stenosis requires careful monitoring of hemodynamic parameters.
The indication for termination of pregnancy is severe aortic stenosis or increasing signs of heart failure.
Drug therapy for aortic stenosis is aimed at eliminating arrhythmias, preventing coronary heart disease, normalizing blood pressure, and slowing the progression of heart failure.
Radical surgical correction of aortic stenosis is indicated at the first clinical manifestations of the defect - the appearance of shortness of breath, anginal pain, syncope. For this purpose, balloon valvuloplasty can be used - endovascular balloon dilatation of aortic stenosis.
However, this procedure is often ineffective and is accompanied by subsequent relapse of stenosis. For mild changes in the aortic valve leaflets (more often in children with congenital defects), open surgical repair of the aortic valve (valvuloplasty) is used.
In pediatric cardiac surgery, the Ross operation is often performed, which involves transplanting the pulmonary valve into the aortic position.
If indicated, plastic surgery of supravalvular or subvalvular aortic stenosis is performed.
The main treatment method for aortic stenosis today remains aortic valve replacement, in which the affected valve is completely removed and replaced with a mechanical analog or xenogeneic bioprosthesis.
Patients with a prosthetic valve require lifelong anticoagulants. In recent years, percutaneous aortic valve replacement has been practiced.
Aortic stenosis may be asymptomatic for many years. The appearance of clinical symptoms significantly increases the risk of complications and mortality.
Basic, prognostic significant symptoms are angina pectoris, fainting, left ventricular failure - in this case, the average life expectancy does not exceed 2-5 years. With timely surgical treatment aortic stenosis, the 5-year survival rate is about 85%, the 10-year survival rate is about 70%.
Measures to prevent aortic stenosis come down to the prevention of rheumatism, atherosclerosis, infective endocarditis and other contributing factors. Patients with aortic stenosis are subject to medical examination and observation by a cardiologist and rheumatologist.
Source: http://www.krasotaimedicina.ru/diseases/zabolevanija_cardiology/aortic-stenosis
From this article you will learn: what aortic stenosis is, what are the mechanisms of its development and the causes of its occurrence. Symptoms and treatment of the disease.
Aortic stenosis is a pathological narrowing of the large coronary vessel, through which blood from the left ventricle enters the vascular system (into the systemic circulation).
What happens during pathology? By various reasons(congenital malformations, rheumatism, calcification) the lumen of the aorta narrows at the exit from the ventricle (in the valve area) and impedes the outflow of blood into the vascular system. As a result, the pressure in the ventricular chamber increases, the volume of blood ejected decreases, and over time various signs of insufficient blood supply to the organs appear (fatigue, weakness).
Disease for a long time is completely asymptomatic (decades) and appears only after the vessel lumen has narrowed by more than 50%. The appearance of signs of heart failure, angina pectoris (a type coronary disease) and fainting greatly worsens the patient’s prognosis (life expectancy is reduced to 2 years).
The pathology is dangerous due to its complications - long-term progressive stenosis leads to irreversible enlargement of the chamber (dilatation) of the left ventricle.
In patients with severe symptoms (after narrowing the lumen of the vessel by more than 50%), cardiac asthma, pulmonary edema, acute heart attack myocardium, sudden cardiac death without obvious signs of stenosis (18%), rarely - ventricular fibrillation, equivalent to cardiac arrest.
It is impossible to completely cure aortic stenosis.
Surgical treatment methods (valve replacement, lumen expansion using balloon dilatation) are indicated after the first signs of aortic narrowing (shortness of breath with moderate exertion, dizziness) appear.
In most cases, the prognosis can be significantly improved (more than 10 years for 70% of those operated on). Dispensary observation carried out at any stage throughout life.
Click on photo to enlarge
A cardiologist treats patients with aortic stenosis, surgical correction performed by cardiac surgeons.
Weak link great circle blood circulation (from the left ventricle blood flows through the aorta to all organs) - tricuspid aortic valve at the mouth of the vessel. When it opens, it allows portions of blood into the vascular system, which the ventricle pushes out during contraction and, when closed, prevents them from moving back. It is in this place that characteristic changes in the vascular walls appear.
With pathology, the tissue of the valves and aorta undergoes various changes. These can be scars, adhesions, adhesions connective tissue, deposits of calcium salts (hardening), atherosclerotic plaques, congenital valve malformations.
Due to these changes:
As a result, insufficient blood supply to all organs and tissues develops.
Aortic stenosis can be:
All three forms can be congenital, acquired - only valvular. And since the valvular form is more common, when speaking about aortic stenosis, this form of the disease is usually meant.
Pathology very rarely (in 2%) appears as an independent disease, most often it is combined with other defects (mitral valve) and diseases cardiovascular system(coronary heart disease).
For decades, stenosis occurs without showing any signs. On early stages(before the lumen of the vessel closes by more than 50%), the condition may manifest itself as general weakness after serious physical activity (sports training).
The disease progresses gradually: shortness of breath appears with moderate and basic exercise, accompanied by increased fatigue, weakness, and dizziness.
Aortic stenosis with a decrease in the lumen of the vessel by more than 75% is accompanied by severe symptoms of heart failure: shortness of breath at rest and total loss ability to work.
Common symptoms of aortic narrowing:
The appearance of pronounced signs of circulatory disorders (dizziness, loss of consciousness) greatly worsens the prognosis of the disease (life expectancy no more than 2–3 years).
After narrowing the lumen of the vessel by 75% cardiovascular failure quickly progresses and becomes more complicated:
Aortic valve stenosis can cause sudden death without any external manifestations or preliminary symptoms.
It is impossible to completely cure the pathology. A patient with any form of aortic narrowing needs to be observed, examined and follow the recommendations of a cardiologist throughout his life.
Drug therapy is prescribed in the early stages of stenosis:
Treatment goals:
At later stages, drug therapy is ineffective; the patient's prognosis can only be improved with the help of surgical treatment methods (balloon dilatation of the aortic lumen, valve replacement).
The attending physician prescribes a set of medications individually, taking into account the degree of stenosis and symptoms of concomitant diseases.
The following medications are used:
| Cardiac glycosides | Digitoxin, strophanthin | Reduce heart rate, increase their strength, the heart works more efficiently |
| Beta blockers | Coronal | Normalize heart rhythm, reduce the frequency of ventricular extrasystoles |
| Diuretics | Indapamide, veroshpiron | Reduce the volume of fluid circulating in the body, reduce blood pressure, relieve swelling |
| Antihypertensive drugs | Lisinopril | Have a vasodilating effect, reduce blood pressure |
| Metabolic agents | Mildronate, preductal | Normalize energy metabolism substances in myocardial cells |
In the early stages, acquired aortic valve stenosis must be protected from possible infectious complications(endocarditis). Patients are recommended a prophylactic course of antibiotics for any invasive procedures (tooth extraction).
Methods of surgical treatment of aortic stenosis are indicated at the following stages of the disease:
In late stages (the lumen of the vessel is closed by more than 75%), surgical intervention is contraindicated in most cases (80%) due to possible development complications (sudden cardiac death).
Lifelong patient:
Prevention of acquired stenosis comes down to eliminating possible causes and risk factors for the development of pathology.
Necessary:
For patients with cardiovascular pathologies, the optimal balance of potassium, sodium, and calcium in the diet is of great importance, so the diet should be discussed with your doctor.
Aortic stenosis has been asymptomatic for decades. The prognosis depends on the degree of narrowing of the artery lumen - reducing the diameter of the vessel to 30% does not complicate the patient’s life.
At this stage, regular examinations and monitoring by a cardiologist are indicated.
The disease progresses slowly, so the symptoms of increasing heart failure are not noticeable to others and the patient (14–18% of patients die suddenly, without obvious signs of narrowing).
But in most cases, difficulties arise after the vessel is blocked by more than 50%, the appearance of attacks of angina pectoris (a type of coronary artery disease) and sudden fainting. Heart failure progresses rapidly, becomes complicated and greatly reduces the patient's life expectancy (from 2 to 3 years).
Congenital pathology ends in death in 8–10% of children in the first year of life.
Timely surgical treatment improves the prognosis: more than 85% of those operated on survive for up to 5 years, and 70% for more than 10 years.
Source: http://okardio.com/bolezni-sosudov/aortalnyj-stenoz-551.html
The human heart is a complex and delicate, but vulnerable mechanism that controls the functioning of all organs and systems.
There are a number negative factors, starting with genetic disorders and ending with an incorrect lifestyle, which can cause malfunctions in the functioning of this mechanism.
Their result is the development of diseases and pathologies of the heart, which include stenosis (narrowing) of the aortic mouth.
Stenosis of the aortic mouth (aortic stenosis) is one of the most common in modern society heart defects. It is diagnosed in every fifth patient after the age of 55 years, with 80% of patients being men.
In patients with this diagnosis, there is a narrowing of the aortic valve opening, which leads to disruption of blood flow into the aorta from the left ventricle. As a result, the heart has to exert considerable effort to pump blood into the aorta through the reduced opening, which causes serious disruption in its operation.
Aortic stenosis can be congenital (occurs as a result of intrauterine developmental anomalies), but more often it develops during a person’s life. The causes of the disease include:
Risk factors for developing the disease include wrong image life (in particular, smoking), renal failure, calcification of the aortic valve and the presence of its artificial substitute - the biological tissue from which they are made is significantly susceptible to the development of stenosis.
Aortic stenosis has several forms, which are distinguished according to different criteria (localization, degree of blood flow compensation, degree of narrowing of the aortic opening).
The course of aortic stenosis is characterized by five stages:
See more about the disease in this animation:
Quality and life expectancy of a patient with aortic stenosis depends on the stage of the disease and severity clinical signs . People with a compensated form without severe symptoms do not have a direct threat to life, but the symptoms of left ventricular hypertrophy are considered prognostically unfavorable.
Full compensation can persist for several decades, but as stenosis develops, the patient begins to feel weakness, malaise, shortness of breath and other symptoms that increase over time.
In patients with the “classic triad” (angina, syncope, heart failure), life expectancy rarely exceeds five years.
Besides, in the last stages of the disease there is high risk sudden death– Approximately 25% of patients diagnosed with aortic stenosis die suddenly from fatal ventricular arrhythmias (usually these include people with severe symptoms).
The most common complications of the disease include:
Often, signs of aortic stenosis do not appear for a long time. Among the symptoms that are characteristic of this disease are:
The disease is often diagnosed accidentally(during preventive examinations) or in later stages due to the fact that patients attribute symptoms to overwork, stress or adolescence.
It is important to understand that any signs of aortic stenosis (rapid heartbeat, pain, shortness of breath, discomfort during physical activity) is a serious reason to consult a cardiologist.
Diagnosis of stenosis of the defect is complex and includes the following methods:
There is no specific therapy for aortic stenosis, therefore treatment tactics are selected based on the stage of the disease and the severity of symptoms. In any case, the patient must register with a cardiologist and be under strict supervision. It is recommended to undergo an ECG every six months, avoid bad habits, diet and strict daily routine.
Patients with stages I and II of the disease are prescribed drug therapy aimed at normalization of blood pressure, elimination of arrhythmia and slowing down the progression of stenosis. It usually includes taking diuretics, cardiac glycosides, and drugs that lower blood pressure and heart rate.
Radical methods for the initial stages of aortic stenosis include cardiac surgery. Balloon valvuloplasty(introduce into the aortic opening special cylinder, after which it is inflated mechanically) is considered a temporary and ineffective procedure, after which in most cases a relapse occurs.
IN childhood doctors usually resort to valvuloplasty(surgical valve repair) or Ross's operations(transplantation of the pulmonary valve to the position of the aorta).
At stages III and IV of aortic stenosis, conservative drug treatment does not give the desired effect, so patients undergo aortic valve replacement. After surgery, the patient should Take blood thinners throughout your life which prevent the formation of blood clots.
If it is impossible to perform surgical intervention, they resort to pharmacological therapy in combination with herbal medicine.
There are no methods to prevent congenital aortic stenosis or to diagnose it in utero.
Preventive measures for acquired defects include V healthy way life, moderate physical activity and timely treatment of diseases that can provoke narrowing of the aorta (rheumatic heart disease, acute rheumatic fever).
Any heart disease, including aortic stenosis, is potentially life-threatening. To prevent the development of heart pathologies and defects, very it is important to take responsibility for your health and lifestyle, as well as regularly undergo preventive examinations, which can detect diseases at the initial stages of their development.
Moderate aortic stenosis is a condition in which the opening in the aortic valve narrows, causing an obstruction of blood flow from the left ventricle. This pathology is considered a heart defect and occurs in both adults and children. According to statistics, it most often develops in older people, predominantly males. Aortic stenosis has an extensive classification: according to the nature of its occurrence, according to the severity of the course, according to the degree and location of the narrowing.
Depending on where the narrowing occurs, there are 3 forms of the disease: subvalvular, supravalvular and valvular.
Subvalvular aortic stenosis, like valvular stenosis, can be congenital or acquired. The supravalvular type of narrowing is only of congenital origin.
Based on how narrowed the opening in the valve is, 3 degrees of pathology are distinguished: minor, moderate and severe. Stenosis is considered minor if the orifice area reaches sizes from 1.2 to 1.6 cm. With a moderate degree - 0.75 -1.2 cm. Severe (severe) aortic stenosis is characterized by narrowing of the valve to such a state that the orifice area does not exceed 0.7 cm.
Normal condition and 3 degrees of aortic stenosis: minor, moderate and severe
As separate forms of this disease, there are 2 more types of it: aortic stenosis and subaortic stenosis.
The characteristics of the latter are as follows:
Aortic stenosis is characterized by more complex diagnostics, since it is detected when the hole in the valve is narrowed by 30%. This defect develops against the background of other heart diseases and is observed more often in men.
Aortic stenosis is one of those diseases that can occur for a long time without appearing in any way. The disease progresses through 5 stages:
With timely initiation of treatment after the onset initial signs pathology, the prognosis will be relatively good. Concomitant diseases such as severe hypotension or endocarditis can aggravate the course of the disease.
In people suffering from aortic stenosis, the symptoms of the disease are as follows:
With aortic stenosis, the properties of the pulse also change.
Before finding out the reasons for the development of aortic stenosis, it should be noted that the pathology can be congenital or acquired.
The congenital form accounts for about 10% of all cases of the disease and is the result of an abnormal development of the aortic valve and its various defects. It is considered normal when the valve has 3 leaflets. They regulate the flow of blood from the left ventricle to the aorta. In case of congenital pathology, this element will consist of two or one valve.
A bicuspid or single-leaf valve differs from a normal valve in having a narrower lumen, which prevents the optimal outflow of blood. This causes overload of the left ventricle.
Normal tricuspid and abnormal bicuspid aortic valves
In the vast majority of cases, aortic stenosis is an acquired heart defect. This pathology begins to occur in adults after they reach 60 years of age. Experts identify a number of factors that increase the risk of developing aortic stenosis. These include smoking, high blood cholesterol, and hypertension.
Acquired aortic valve stenosis develops as a result of the following reasons:
In patients with rheumatism, the valve leaflets are affected, which causes them to contract. As a result of this process, they become dense and lose flexibility, which causes the hole in the valve to narrow. Salt deposits on the aortic valve often lead to decreased mobility of the valves. As a result of this, narrowing also occurs.
Such pathological transformations also occur when infective endocarditis. In some cases, degenerative processes observed in the valve itself lead to aortic stenosis. They begin to appear in people after 60 years of age. Since this reason is related to age-related changes and valve wear, the disease is called idiopathic aortic stenosis.
Degenerative processes that cause stenosis also occur with atherosclerosis of the aorta itself. In this case, sclerosis occurs and the mobility of the valves is impaired. With aortic stenosis, an obstructive process in the heart is observed - difficulty in the movement of blood flow into the aorta from the left ventricle.
In newborns and preschool children, this pathology may occur without symptoms, but as they grow, stenosis will begin to appear. There is an increase in the size of the heart and, accordingly, the volume of circulating blood, and the narrow lumen in the aortic valve remains unchanged.
Narrowing of the aortic valve in newborns occurs due to abnormal development of the valves during fetal development. They grow together or do not separate into 3 separate valves. You can see such a pathology in the fetus as early as 6 months of pregnancy using echocardiography.
Such a diagnosis is mandatory and very important, since immediately after birth the child develops critical stenosis. The danger of the condition is that the left ventricle with aortic stenosis works with excessive increased load. But it will not be able to function in this mode for a long time. Therefore, if such a pathology is detected in time, it is possible to perform surgery after the birth of the child and prevent an unfavorable outcome.
Critical stenosis occurs when the lumen in the aortic valve is less than 0.5 cm. Non-critical stenosis causes a deterioration in the child’s condition during the first year of his life, but for several months after birth the baby may feel quite satisfactory. In this case, poor weight gain and tachycardia with shortness of breath will be noted. In any case, if parents suspect signs of illness in their child, they should consult a pediatrician.
You can guess about aortic stenosis in a newborn by the following signs:
For older children, the situation is not as bad as for newborns. Signs of the defect may not appear for a long time, and it is possible to track the development of the pathology over time by selecting an appropriate correction method. Ignore obvious signs the disease cannot be treated, it must be treated, since it may have death. There are 3 options for the development of pathology, as a result of which the methods for eliminating it are different:
The main method by which aortic valve stenosis is detected is considered ultrasound examination hearts. If ultrasound is performed in combination with Doppler, it is also possible to evaluate the speed of blood flow. A traditional ECG allows us to identify only some of the accompanying signs of this pathology, characteristic of its later stages. Auscultation is also used; it will allow you to determine a rough murmur in the heart due to aortic stenosis. However, listening alone cannot be the basis for making a final diagnosis. It only indicates a possible pathology.
ECG of a patient with aortic stenosis. Left atrial hypertrophy. Hypertrophy and systolic overload of the left ventricle
A minor illness in the absence of complaints from the patient does not require therapeutic measures. Treatment of aortic stenosis becomes necessary when threatening symptoms increase, which indicate the progression of the disease, which is life-threatening. To slow down this process if it is not possible surgical intervention, the patient is prescribed medication.
Your doctor will recommend taking diuretics to reduce your risk of heart failure. In addition, as part of drug therapy, antiarrhythmic drugs and medications are prescribed to normalize blood pressure. One of the directions conservative therapy is the elimination or prevention of atherosclerosis.
Drug therapy is prescribed to those patients who, for objective reasons, are not subject to surgical treatment or it is not yet indicated for them due to the slow course of the disease without pronounced symptoms. Medications to eliminate aortic stenosis are selected individually, taking into account the reasons that caused this disease.
Conservative treatment of stenosis is also indicated for those patients who have already undergone valve replacement surgery. This does not apply to all operated patients, but only to those in whom this manipulation was caused by rheumatism. For them, the main therapeutic goal is the prevention of endocarditis.
This inflammatory disease lining of the heart and valves. Since it has an infectious nature of development, antibacterial drugs are used to treat it. medications. The appropriate medications and duration of their use are determined by the attending physician. You need to be prepared for the fact that therapy can be either long-term or lifelong.
The main treatment methods for severe aortic stenosis consist of surgically replacing the damaged valve. The following surgical techniques are used for this:
Aortic valve replacement
Open surgery involves opening chest and artificial. Despite the complexity and trauma, such an intervention is a highly effective method of aortic valve replacement. As a replacement, artificial valves made of metal and donor valves borrowed from animals are used. If a metal prosthesis is installed, the patient must take anticoagulants—blood thinning drugs—for the rest of his life. This is due to the fact that surgery increases the risk of blood clots. The donor prosthesis is sewn in temporarily, its service life is no more than 5 years. After this period has expired, it needs to be replaced.
Balloon valvuloplasty is used to treat children. This technique is not suitable for adult patients, since the valve leaflets become more fragile with age and can be destroyed as a result of the intervention. For this reason, it is carried out in exceptional cases for men and women. One of them is the impossibility of using general anesthesia.
Aortic balloon valvuloplasty
The operation is performed as follows: through femoral artery A special balloon is inserted, which expands the narrowed lumen of the aorta. All manipulations are carried out under radiographic control. Observation of patients who have undergone a similar procedure shows that re-narrowing of the valve occurs. In addition, in rare exceptions, such treatment can cause complications - these are:
Percutaneous valve replacement is performed on the same principle as balloon valvuloplasty. The only difference is that in this case an artificial valve is installed, which opens after it is inserted through the artery. It presses tightly against the walls of the vessel and begins to perform its functions. Although this method of replacing the aortic valve is minimally traumatic, it has many contraindications. Therefore, it is not suitable for all patients with such pathology as aortic stenosis.
Aortic stenosis is also called aortic stenosis or aortic stenosis. Simply put, this is a narrowing of the aortic opening along various reasons. The pathology is unpleasant because it significantly reduces life expectancy (if left untreated!) - from 15 to 20 percent may suffer sudden death.
Disease statistics show that congenital stenosis is most often diagnosed before the age of 30, and rheumatic stenosis after that. In some cases, aortic stenosis is accompanied by other pathologies.
Failure to see a doctor in a timely manner can lead to radical treatment in the form of an aortic valve transplant. The operation is far from cheap, so it’s better to get by drug therapy and prevention.
Stenosis in medical practice means a narrowing of the organic nature of a vessel, hollow organ, canal, or duct. In this case, there is a complete or partial obstruction of the patency of the stenotic area.
Stenosis occurs:
All stenoses, regardless of their nature, can be single or multiple.
Aortic stenosis is a pathology of the semilunar valve of the aorta, which consists of narrowing of its outflow tract. This defect is a heart defect and is characterized by obstructed blood flow from the left ventricle during systole.
In this case, a pronounced pressure difference arises between the aorta and the left ventricular chamber, and the load on the heart muscle increases in all parts of the heart. Over time there is pronounced violation hemodynamics.
For reference! Aortic stenosis (stenosis of the aortic mouth) is up to 4 times more common in men.
In cardiological practice, the most common lesion of the aortic valve is combined with other heart defects.
An isolated lesion is recorded very rarely - in only 1.5% of cases.
For reference! Of all valve defects, aortic stenosis accounts for approximately 25% of all cardiac malformations.
The main pathogenetic links of such a disease consist in the development of sequential reactions:
For reference! With the development of hypoxia, all vital organs are affected, especially the brain, which has small reserves of glucose and, in conditions of lack of oxygen, is susceptible to the development of vascular accidents.
First of all, aortic valve stenosis is divided into types according to origin: 
According to the location of aortic stenosis, it can be:
Cardiologists use pressure gradient data to assess the degree of aortic stenosis.
For reference! The pressure gradient is the difference in blood pressure in the left ventricle before and after the aortic valve. In the absence of narrowing, the pressure is minimal, and the more pronounced the narrowing, the higher the pressure becomes.
Under physiological conditions, the aortic valve opening ranges from 2.5 to 3.5 cm2. In such cases, blood flows without obstruction, delivering the required amount of oxygen from the heart to the tissues.
In the case of development of stenosis, depending on the severity of the narrowing of the aortic mouth, several degrees of severity are distinguished, which is determined by the area of opening of the valve leaflets and the pressure difference. Aortic stenosis and its gradient classification are as follows:
Aortic stenosis is characterized by hemodynamic disturbances, which depend on the degree of narrowing of the aortic orifice. In this case, clinicians divide the disease into several stages:
For reference! Aortic stenosis can be compensated, when it is still possible to help patients, and decompensated, when only short-term symptomatic help is possible. This phenomenon is called critical aortic stenosis.
Often acquired aortic stenosis is caused by damage to the valves of rheumatic origin. The basis of this defeat is deformation of the valve leaflets, their fusion, compaction, weakness, which leads to a narrowing of the aortic mouth.
Among the adult population, heart defects such as aortic stenosis or aortic orifice/aortic valve stenosis are common. There are many pathological conditions that can lead to this disease. In the absence timely treatment the development of serious complications is possible, in particular bacterial inflammation of the valve leaflets.
Aortic stenosis (AS) is a narrowing of the opening located on the aorta due to fusion of the valve leaflets. Such a disorder is an obstacle to blood flow, as a result of which, against the background of a long course of SA, pathological changes in the left ventricle develop, in severe cases - left ventricular failure.
The first description of aortic stenosis was presented in 1663 by the French physician Lazare Rivière.
Aortic stenosis occurs for several reasons, including congenital malformations, valve calcification, and acute rheumatic fever. To make a diagnosis of narrowing of the aortic orifice, it is important instrumental methods research. Today, two-dimensional (2D) Doppler echocardiography is most commonly used. Both medication and surgery are used for treatment.
Video: Aortic stenosis - “Simply about the complex”
The aortic valve (in Latin valva aortae) is located between the left ventricle (LV) and the mouth of the largest vessel - the aorta, which allows blood to flow in only one direction. The valve is based on three leaflets, but congenital defects there may be two or even one leaf. Normally they open towards the aorta.
In SA, the valves are connected to each other due to inflammatory or destructive processes. This leads to a narrowing of the lumen through which blood begins to pass from the left ventricle to the aorta under high pressure.
Severity of aortic stenosis:
Severe aortic stenosis rarely occurs in infancy, with an incidence rate of 0.33% among live newborns, who mostly have a unicuspid or bicuspid valve.
Pathogenesis of SA
When the aortic valve is damaged and stenosis develops, resistance to systolic output occurs. This obstruction of blood flow leads to an increase in systolic pressure in the left ventricle (LV). As a compensatory mechanism to normalize the condition, the thickness of the LV walls increases due to the parallel replication of sarcomeres, causing concentric hypertrophy. At this stage, the chamber does not expand, and ventricular function is preserved.
With prolonged development of AS, LV end-diastolic pressure increases, which causes a corresponding increase in pressure in the small arteries of the lungs and a decrease in cardiac output due to diastolic dysfunction. Cardiac contractility (a measure of systolic function) may also decrease, further contributing to decreased cardiac output. Ultimately, heart failure develops.
In many patients with aortic stenosis, LV systolic function is preserved, and cardiac output is not disturbed over many years of life, although LV systolic pressure may be increased. Although cardiac output is normal at rest, it often increases inappropriately during exercise, which can lead to symptoms during exercise.
Some statistics on aortic stenosis:
Aortic stenosis can be congenital or acquired. In each case we consider specific reasons development of the disease.
Congenital aortic valve stenosis
Congenital unicuspid, bicuspid, tricuspid, or even quadricuspid valves often contribute to the development of SA. In newborns and children under 1 year of age, a unicuspid valve can cause severe narrowing. It is the most common anomaly in newborns with fatal valvular aortic stenosis. In patients under 15 years of age, unicuspid valves are most common in symptomatic CA.
In adults with symptoms of congenital AS, the problem is usually the bicuspid valve. Such disorders do not cause significant narrowing of the aorta in childhood. The modified design of the bicuspid aortic valve provokes the formation of turbulent flow with continuous trauma to the leaflets. Ultimately, this leads to fibrosis, increased stiffness and calcification, and this is a direct path to narrowing of the aorta in adulthood.
The Tzemos study, which included 642 adults with bicuspid aortic valves, found that during follow-up average duration At 9 years, the survival rate was determined to be no lower than that of the general population. However, young people with a bicuspid aortic valve had a high risk of surgical intervention due to aortic valve reconstruction.
Congenital anomalies of the tricuspid aortic valve with irregular leaflets (“functionally bicuspid” valves) can also cause turbulent flow, leading to fibrosis and ultimately calcification and stenosis.
Clinical manifestations of congenital aortic stenosis in adults usually appear after the fourth decade of life.
Acquired aortic stenosis
The main causes of acquired aortic stenosis are:
Degenerative calcification of aortic stenosis (also called senile calcified aortic stenosis) is a progressive calcification of the valve leaflets, resulting in limited opening during systole.
Risk factors for degenerative calcified aortic stenosis include:
In rheumatic aortic stenosis, the main process is progressive fibrosis of the valve leaflets with varying degrees of fusion, often with retraction of the leaflet margins and, in some cases, calcification. As a result, the rheumatic valve ceases to normally allow blood to flow into the aorta.
Other rare causes of aortic stenosis:
It is worth noting that although differentiation is often made between tricuspid and bicuspid aortic stenosis, it is often difficult to determine the number of aortic valve leaflets. In addition, surgical and pathological studies have confirmed frequent discrepancies with previously made assumptions.
Symptoms of aortic stenosis usually develop gradually after an asymptomatic latent period, often lasting 10-20 years.
The classic triad of symptoms in patients with aortic stenosis is as follows:
Systolic hypertension can be combined with aortic stenosis. However, systolic blood pressure is above 200 mm Hg. Art. rare in patients with critical SA.
Physiological examination reveals following signs Aortic stenosis:
For evaluation general condition the patient is determined by:
From instrumental ways diagnostics are used:
The only definitive treatment for aortic stenosis in adults is aortic valve replacement (surgical or percutaneous). Infants, children, and adolescents with bicuspid valves may undergo balloon or surgical valvotomy.
Ambulance
A patient suffering from decompensated heart failure should be transported to the hospital as quickly as possible, where he can be monitored for pulmonary and cardiac activity. The medical staff will also make intravenous access through which, if necessary and tolerable, loop diuretics, nitrates, and morphine will be administered.
Patients with severe heart failure due to aortic stenosis who are refractory to medical intervention are usually referred for emergency surgery.
Pharmacological therapy
Drugs used in the treatment of patients with aortic stenosis include the following:
Digoxin, diuretics, ACE inhibitors or angiotensin receptor blockers - recommended by the European Society of Cardiology (ESC)/European Association of Cardiothoracic Surgery (EACTS) for patients with symptoms of heart failure who are not eligible for surgery or transcatheter aortic implantation
Aortic valve replacement
Percutaneous balloon valvuloplasty
This minimally invasive technique is used as a palliative measure to treat critically ill adults who cannot undergo standard surgery. In other cases, it is used to temporarily improve the condition of a patient preparing for aortic valve replacement.
Asymptomatic patients, even with critical aortic stenosis, are given an excellent survival prognosis with a mortality rate of less than 1% per year, while only 4% of sudden cardiac deaths in severe aortic stenosis are associated with asymptomatic disease.
Among symptomatic patients with moderate to severe aortic stenosis, mortality from symptom onset is approximately 25% in the first year and 50% after two years. More than 50% of deaths are sudden.
Patients with untreated aortic valve stenosis have a poor prognosis when symptoms appear.
Although AS tends to progress more rapidly in the setting of degenerative aortic valve calcification than in congenital or rheumatic disease, accurate prediction of the rate of progression in individual patients is not possible.
Catheterization and echocardiographic studies show that on average the valve area decreases by 0.1-0.3 square meters. cm per year; in this case, the systolic pressure gradient through the valve can increase by 10-15 mm Hg. Art. per year.
A more rapid progression of SA is observed in older patients with coronary artery disease and chronic renal failure.
Video: Live Healthy! Aortic stenosis
