Aortic stenosis

Cause pathogenesis of rheumatic aortic stenosis thickening of the valve leaflets, junction adhesion, shorten a valve insufficiency often accompanied by the closure of the normal aorta mouth area of 3 cm2. When the valve area "at the rim, left ventricular blood blocked row, left ventricular pressure. Left ventricular - aortic pressure gradient between the increased left ventricular hypertrophy. Beware the emergence of dysfunction, left ventricular expansion, reduce compliance, reduced cardiac output, left ventricular end-diastolic pressure increased, and pulmonary congestion. Due to reduced cardiac output and left ventricular hypertrophy, myocardial oxygen consumption increased activity may have myocardial ischemia, angina and various arrhythmias. A clinical performance, the mild symptoms can be asymptomatic for many years. Severe stenosis can be syncope, angina or heart failure, a few cases of sudden death can occur, was due to myocardial ischemia-induced ventricular fibrillation and cardiac arrest. 2, the obvious signs of left ventricular hypertrophy, there apexcardiogram under the left shift. Aortic valve District 4 -5 - projectile systolic murmur to the neck conduction; Systolic accompanied by small tremor, - the typical signs of the disease, aortic valve and the second is to reduce noise reverse split, a small number of patients with systolic can hear jet noise. Severe stenosis, the apex fourth heart sounds to be heard, left ventricular dysfunction, the apex third heart sounds to be heard, the pulse pressure change. Laboratory and one other inspection, X-ray early or mild stenosis affect normal heart, the late left ventricular increased, aortic arch subject to long-term hemodynamic effect of a narrow jet after expansion. 2, ECG strain and left ventricular hypertrophy. 3, echocardiographic aortic valve thickening, and the slower pace of opening a lesser extent, left ventricular wall thickening, Doppler ultrasound to detect aortic systolic turbulence spectrum. Four cardiac catheters, left ventricular catheter said left ventricular - aortic pressure gradient between the increase. Left ventricular angiography revealed aortic valve stenosis. Diagnosis and differential diagnosis based on typical signs, X-ray, electrocardiogram and cardiac catheterization and angiography can clear diagnosis, and the need to pay attention to other causes of aortic stenosis differential. 1, congenital aortic valve stenosis, aortic stenosis often sinus tissue on the crest of congenital anomalies, while vascular anomalies, accompanied with mental retardation and stunted growth, facial abnormalities, and more than 400,000 deaths a year. Multi-valve stenosis of outflow tract caused muscle fibers. Adult valve stenosis for more than two aortic valve flow of long-term impact. Prone to valvular calcification thickening or fibrosis often associated with coarctation of the aorta or other congenital cardiovascular malformations coexist, Yi with infective endocarditis. Ultrasonic and left ventricular angiography to differentiate. 2, senile degenerative aortic valve calcification induced aortic valve stenosis was common in the elderly. Calcified valve located in the root, the valve leaflets activity is fairly good, without systolic jet noise, X-ray, we can see valve calcification. 3, primary hypertrophic obstructive cardiomyopathy hypertrophic obstructive cardiomyopathy has the following characteristics may help distinction : ① systolic murmur projectile parts of the lower, more in the left margin sternum III-IV intercostal the loudest and less conductive to the neck, upon reflection noise in the output reduction or ventricular contractility strengthened to enhance, on the contrary it is weakening. ② second aortic heart sounds normal. ③ without systolic jet noise. ④ echocardiography icon in ventricular septal and free wall thickness ratio "was 13:1, the left ventricular cavity smaller, Left ventricular outflow tract obstruction ( "= 20mm, mitral systolic anterior leaflet prior to the campaign, aortic valve closure of the mid-contraction. ⑤ angiocardiography, left ventricular cavity revealed cone change. Apart from the complications of syncope, angina, heart failure, about 3 -5% of asymptomatic patients with sudden death can occur. have symptoms of sudden death accounted for 15 -20%, with aortic valve regurgitation, susceptible to infectious endocarditis. a treatment, medical treatment ① symptomatic patients should limit physical activity, to prevent syncope, angina and sudden death. heart failure, the use of diuretics and vasodilators. Due to the need to avoid sharp upon reflection output due to the reduction of left ventricular filling a sudden drop in the syncope, and other symptoms. ② the kinds of equipment inspection, before and after surgery, the prevention and control of infectious endocarditis. ③ with atrial fibrillation or tachycardia. timely treatment is needed, so as not to affect cardiac output. ④ to aortic valve stenosis mainly of young patients, if symptoms Valve activity, and no calcification, consider first percutaneous balloon dilatation catheter angioplasty. If accompanied by obvious incompetence, still OK suitable valve replacement surgery. 2. Surgical treatment of valve replacement surgery indications for ① syncope or a history of angina. ② electrocardiographic left ventricular hypertrophy and said fatigue . ③ heart function III-IV class. ④ left ventricular - aortic pressure gradient between "6.65kpa (mmHg).