Aortic stenosis, or aortic stenosis - congenital or acquired disease characterized by narrowing of the left ventricular outflow tract in the aortic valve, which provokes the difficulty of outflow of blood from the left ventricle, as well as contribute to a sharp increase in the pressure gradient between the aorta and ventricle.
Types and causes of aortic stenosis
There are three types of aortic stenosis:
- valves (congenital or acquired);
- supravalvular (only natural);
- subvalvular (congenital or acquired).
The main causes of acquired aortic stenosis are:
- atherosclerosis of the aorta;
- degenerative changes in the valves and their subsequent calcification;
- rheumatic valvular leaflets (the most common cause of the disease);
- infective endocarditis.
Rheumatic valve cusps (rheumatoid endocarditis) provokes a reduction of the valve leaflets, as a result they become rigid and thick, which is the cause narrowing of the valve opening. Often there is calcification of the aortic valve, which helps further reduce the mobility of the leaflets.
If infective endocarditis observed similar changes, leading to the development of aortic stenosis. Part of the reason the formation of the disease are systemic lupus erythematosus and rheumatoid arthritis.
Atherosclerosis of the aorta is accompanied by severe degenerative processes sclerosis, stiffness and calcification of the valve cusps of the fibrous ring, which also contributes to the difficulty of outflow of blood from the left ventricle.
Sometimes in the elderly cause of aortic stenosis are primary degenerative changes of the valve. This phenomenon is called "idiopathic calcific aortic stenosis."
Congenital aortic stenosis occurs as a result of defects and developmental abnormalities of the valve. In the later stages of the disease the symptoms of aortic stenosis joins pronounced calcification, which aggravates the disease.
Thus, in all patients at a certain degree of aortic stenosis, regardless of the cause of observed distortion aortic valve calcification and expressed.
Symptoms of aortic stenosis
Depending on the degree of aortic stenosis, patients can for a long time does not experience any discomfort, i.e. for a long time the disease has no symptoms.
In marked narrowing of the valve opening, patients start complaining about the appearance of angina attacks, fatigue and weakness during exercise, fainting and dizziness with rapid change in body position, shortness of breath. In severe cases, symptomatic aortic stenosis are attacks of breathlessness (pulmonary edema or cardiac asthma).
In patients with isolated aortic stenosis may occur complaints related to the appearance of signs of right ventricular failure (heaviness in the right upper quadrant, swelling). Experiencing these symptoms of aortic stenosis with significant pulmonary hypertension due to mitral valve in combination with aortic stenosis.
At the general examination of the patient had been a characteristic pale skin.
Diagnosis of aortic stenosis
The main methods of instrumental diagnosis of aortic stenosis include:
- X-ray examination;
- Heart catheterization
Treatment of aortic stenosis
In severe aortic stenosis, drug therapy is usually ineffective. The only radical method of treatment is aortic valve replacement. Even after the onset of symptoms of the disease the chances of survival without surgery dramatically reduced. On average, the patients after the onset of symptoms such as pain in the heart, signs of left ventricular failure, fainting, do not live more than five years.
After the diagnosis "aortic stenosis" patient necessarily recommend preventive measures against infectious endocarditis.
In asymptomatic aortic stenosis drug therapy aimed at maintaining sinus rhythm, prevention of coronary heart disease and blood pressure normalization.
After the appearance of the complaints in the impossibility of carrying out the operation prescribed medication. So, if you have heart failure with medication try to eliminate congestion in the pulmonary circulation by receiving diuretics. But too active use can contribute to the development of excessive urine output, hypovolemia, and hypotension. If left ventricular systolic dysfunction as symptomatic treatment is prescribed digoxin, especially for atrial fibrillation.
When aortic stenosis patient vasodilators are contraindicated, since they can lead to fainting. However, in severe heart failure may be cautious administration of sodium nitroprusside.
In congenital aortic stenosis in children can be used aortic balloon valvuloplasty. This method reduces the maximum transvalvular gradient of 65%, but mostly this method requires a second operation for 10 years. After the valvuloplasty patients may develop aortic insufficiency.
The most effective treatment of aortic stenosis is a surgical method of prosthetic aortic valve. Prosthetic aortic valve is indicated for severe aortic stenosis in the following cases:
- the presence of syncope, angina, or heart failure;
- in conjunction with coronary bypass surgery;
- in conjunction with operations in other valves.
Surgical treatment of aortic stenosis significantly improves the patient's state of health and the prognosis of survival. It can be successfully carried out, even in elderly patients, without the risk of severe pathologies. To use autografts prosthetics, dentures allogeneic, allografts, mechanical prostheses or porcine bioprosthesis and bovine pericardial prostheses.