DR Medhat MRCP

Valvular heart disease
Aortic stenosis
سؤال Aortic stenosis –most common cause
Features of severe aortic stenosis
- Narrow pulse pressure
- Slow rising pulse, apico-carotid delay
- Delayed ESM (ejection systolic murmer), maximally over RT 2 nd intercostal space.
- LVH or LVF quieter murmur
- Soft/absent S2
سؤال - S4
- Thrill
- Late sign : exertional syncope (=passing out) سؤال if present ,1 st test is echo.
أهم مافى الموضوع Management
1. If symptomatic Aortic valve replacement (AVR)
2. If asymptomatic observe the patient (regular follow up) is general rule
3. If asymptomatic but
- Valvular gradient > 50 mmHg and with features such as left ventricular systolic
dysfunction consider surgery (AVR)
4. Balloon valvuloplasty
Age < 65 y : bicuspid aortic valve
Age > 65 y : aortic calcification
- Is limited to patients with critical aortic stenosis who are not fit for AVR (mainly
infants & children).
5. Trans-catheter aortic valve implantation (TAVI) :
- In adults with sever aortic stenosis who are unfit for open AVR surgery.
Prosthetic heart valves
- The most common valves which need replacing are the aortic and mitral valve.
- There are two main options for replacement:
1. Biological (bioprosthetic)
2. Mechanical
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