Aortic valve stenosis (adult)
Patient (condition)
 
Aliases:
AS
AVS
Aortic stenosis

Topic aliases are alternate phrasings for a particular topic.


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Severity based on valve area (cm2):
Mild > 1.5,
Moderate 1.0–1.5, Severe < 1.0,
Critical <0.75.
ACC/AHA Practice Guidelines 2008
refl.in/iv
from refl.in/iu

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Severity grading based on mean gradient.
Mean gradient (mmHg):
Normal <5;
mild 5-25;
moderate 25-40;
severe 40-50;
critical > 50.
ACC/AHA Practice Guidelines 2008 refl.in/iv from refl.in/iu

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Nov 05, 2012
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Clinical signs of severity include syncope, exertional angina, slow rising pulse, presence of thrill, displaced apex beat. #ref

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Jul 13, 2011
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Murmur intensity can be a poor predictor of the severity of aortic stenosis in an unselected population if patients with left ventricular-failure (reduces intensity) are included. refl.in/9k

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The site of maximum intensity does not aid differentiation from mitral regurgitation, and the murmur of aortic stenosis may be most easily audible in the ‘mitral area’. refl.in/9k

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Transcatheter aortic-valve-implantation versus Surgical Aortic-Valve Replacement in High-Risk Patients? 2011 NEJM. No difference in mortality, increased risk of stroke at 30days and 1yr. refl.in/7n #improve

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Balloon valvotomy may be a temporay alternative to valve replacement. Discuss options with cardiologist or cardiothorac surgeon.

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Aug 11, 2011
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If patient awaiting valve repair develops relapsing sepsis (eg cholelithiasis/biliary sepsis), it may be better to accept higher risk to fix (cholecystectomy), than risk sepsis after valve repair

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Jun 28, 2011
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If severe, symptomatic disease, ensure any incidental surgery is booked to be done in-hours by consultant anaesthetist and consultant surgeon.

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Jul 02, 2011
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Severe aortic stenosis (valve gradient <1cm2 or symptomatic disease) is one of the active cardiac conditions for which the AHA/ACC guidelines suggest elective surgery should be delayed and the condition evaluated and optimised. Active cardiac conditions - refl.in/jo AHA/ACC Flowchart - refl.in/aha from refl.in/4s

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Avoid tachycardia as this will increase myocardial oxygen demand in a hypertrophied ventricle with already marginal oxygen supply/demand

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Mar 03, 2012
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Maintain high afterload. Hypertrophied left ventricle will be dependent on high diastolic filling pressures to maintain coronary perfusion

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Mar 03, 2012
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Maintain low normal heart rate to prolong systolic ejection phase

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May 18, 2011
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Maintain sinus rhythm where possible. Those with diastolic dysfunction/LVH are dependent on atrial contraction for ventricular filling

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