Tuesday, April 5, 2011

Aortic Stenosis (Surgery)

Aortic stenosis is the narrowing or occlusion of the heart's aortic valve, which prevents it from opening properly and does not let oxygenated blood flow completely out of the left ventricle into the aortic artery, causing this heart chamber to become thicker, which in time can lead to chest pain. If not treated, the pressure inside the left ventricle continues to rise, as blood begin to back up into the lungs, and the patient may feel short of breath. Severe forms of aortic stenosis prevent enough blood from reaching the brain and rest of the body. This can cause light-headedness and fainting. Most commonly, aortic stenosis is due to age-related progressive calcification of the normal trileaflet valve, being responsible for more than 50% of cases.

Other predisposing conditions that might cause aortic stonosis include calcification of a congenital bicuspid aortic valve (40% of cases) and acute rheumatic fever (5% of cases). Typically, aortic stenosis due to calcification of a bicuspid valve manifests when individuals reach their 40s and 50s, whereas that due to calcification of a normal valve tends to manifest later, in the 70s and 80s. Hypertension, diabetes mellitus, hyperlipoproteinemia and uremia may speed up the process. Most people with mild to moderate aortic stenosis do not have symptoms. Symptoms usually are manifest in those with severe aortic stenosis, although they can exist in those with mild to moderate severity as well. The initial presenting symptoms include progressive shortness of breath on exertion, which may be so subtle that they are not consciously aware, but may inadvertently cut down on exertional activities. More worrisome symptoms include syncope, chest pain, and frank heart failure.

If aortic stenosis is mild and asymptomatic, treatment is not necessary in asymptomatic patients. In moderate cases, echocardiography is performed every 1–2 years to monitor the progression, possibly complemented with a cardiac stress test. In severe cases, echocardiography is performed every 3–6 months. In both moderate and mild cases, the patient should immediate make a revisit or be admitted for inpatient care if any new related symptoms appear. In adults, symptomatic aortic stenosis usually requires aortic valve replacement, which decreases the risk of death.

Aortic Stenosis Surgery: Ross Konto Procedure with Aortic Arch Reconstruction (Performed by Dr. Redmond Burke)