Aortic Stenosis: Updates in Diagnosis & Management. Amanda Ryan, D.O. Cardiology Fellow October 10, 2008. Learning Objectives. Following the presentation the participant should be able to: Define aortic stenosis based on echocardiographic guidelines Explain primary causes and risk factors
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Amanda Ryan, D.O.
October 10, 2008
This is the aortic valve viewed from the outflow side, i.e. from the aorta. Blood flows up through the valve from the left ventricle, pushing the cusps out of the way. Two of the three cusps are clearly visible in this view.
Tricuspid (left) and Bicuspid (right) Aortic Valve.
1. increase in afterload
2. decrease in systemic & coronary blood flow from obstruction
3. progressive hypertrophy
44 X SEP X HR X s.r of delta P
SEP is systolic ejection period
P is pressure difference across valve
AVA = LVOTarea X LVOTtvi
AV = aortic valve flow velocity
TVI = time-velocity integral
Calcific Aortic StenosisNote that there are three distinct cusps in this valve, and that the free edges of the cusps appear normal. Heaped up calcific deposits extend from the cusps into the sinuses of Valsalva. This calcification prevents normal opening of the valve. Calcification of the aortic valve may be a result of rheumatic heart disease. The gross appearance illustrated here, however, is characteristic of degenerative ("wear and tear") calcific aortic stenosis in an elderly individual. Bicuspid aortic valves (a congenital abnormality) also tend to calcify, but usually at an earlier age than normal three-cusped valves.
CT Evaluation of Aortic Stenosis
• Excellent Assessment of Calcification
• May establish stenosis severity
• Cannot establish insufficiency
• Good evaluation of mechanical
• Evaluates coronary anatomy in patients
undergoing valve surgery
This enhanced CT image puts you inside the aorta, looking down at the aortic valve. You can clearly see the three valve leaflets, currently closed.
CMR Evaluation of Aortic Stenosis
• Minimally invasive
• Absence of ionizing radiation
• Absence of nephrotoxic contrast agents
• Morphology + physiology
• Simultaneous cardiac evaluation
Examples of replacement aortic valves: a) shows an aortic homograft, b) and c) show a xenograft, d) shows a ball and cage valve, e) shows a tilting-disk valve, f) shows a bi-leaflet valve