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Aortic Valve Disease

Aortic Valve Disease. Soner Sanioğlu , M.D. Assoc . Prof. of Cardivascular Surgery. Anatomy. Pathophysiology. Laplace’s Law WT=PXR/2h. Aortic stenosis. Dejenerative Bicuspid R heumatic. Symptoms. Angina pectoris : CPP=DAP-EDLVP ( survival 5 y)

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Aortic Valve Disease

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  1. AorticValveDisease Soner Sanioğlu, M.D. Assoc. Prof. of CardivascularSurgery

  2. Anatomy

  3. Pathophysiology Laplace’sLaw WT=PXR/2h

  4. Aorticstenosis • Dejenerative • Bicuspid • Rheumatic

  5. Symptoms • Anginapectoris: CPP=DAP-EDLVP (survival 5 y) • Syncope:exercise→ fixed CO→ reducedcerebralperfusion(survival 3 y) • Dyspneaandheartfailure: (survival 2 y)

  6. Signs • systolicejectioncrescendo-decrescendo murmur • Pulsusparvuset tardus

  7. Echo

  8. Medicaltreatment • ß- blocer, HR↓ ejection time ↑ • Diuretic, pulmonarycongestion ↓

  9. Surgicalindications

  10. AorticRegurgitation • Calcificaorticdisease, • Idiopathicdegenerativedisease, • Active orchronicaorticvalveendocarditis, • Rheumaticdisease • Biscuspidaorticvalve, • Myxomatousproliferationof aorticvalvetissue • Anorecticmedications, suchas fenfluramineandphentermine, • Carcinoidsyndrome. • Aorticannulardilatation: aorticdissection; trauma; chronicsystemichypertension; aortitisfromsyphilis, viralsyndromes, orothersystemicarteritides (e.g., giantcellandTakayasu); andconnectivetissuedisorderssuchas Marfansyndrome, Reiterdisease, Ehlers-Danlossyndrome, osteogenesisimperfecta, andrheumatoidarthritis.

  11. Pure AR is rare and is seen commonly only in aortic dissection or annular dilatation. • Most commonly, aortic valvular insufficiency is seen in combination with AS,e.g. rheumatic valvular disease, or myxomatous degenerative disease.

  12. Symptoms • Asymptomaticfor prolonged periods of time • Palpitations • Chestpain • Most symptoms of AR occur from underlying heart failure and pulmonarycongestion • Dyspneaand PND, CHF.

  13. Table 22.2 Signs of aortic insufficiency Sign Finding Corrigan’s pulse Rapid forceful carotid upstroke followed by rapid decline Quincke’s pulse Systolic plethora and diastolic blanching in nail bed when nail is slightly compressed de Musset’s sign Bobbing of head Duroziez’s sign Systolic and diastolic bruit heard over femoral artery when compressed by bell of stethoscope Hill’s sign Augmentation of systolic blood pressure in leg by ³30 mm Hg compared with that in arm Signs

  14. Diastolicmurmur • Austin Flintmurmur, middiastolicapicalmurmur

  15. Medicaltreatment • Vasodilatortheraphy, SVR↓ • Diuretic, pulmonarycongestion ↓

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