Aortic stenosis: symptoms, diagnosis, treatment

Aortic stenosis is a defect characterized by narrowing of the valve, subvalvular or supravalvular orifice. With stenosis, hypertrophy of the left ventricular myocardium develops with a decrease in its cavity, since the left ventricular myocardium works with increased load due to the obstruction of blood ejection into the aorta.

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Symptoms of aortic stenosis

At an early age, most children do not complain and develop well. After relative "well-being", complaints of anginal pains in the heart, periodic shortness of breath, and fainting appear. Fainting (syncopal states) is a sign of severe aortic stenosis with a pressure gradient between the aorta and the left ventricle of more than 50 mm Hg. Short-term loss of consciousness is caused by a decrease in cardiac output. With aortic stenosis, there is a risk of sudden cardiac death, since myocardial hypertrophy is the background for the development of acute coronary insufficiency, especially during physical exertion. The same factor can lead to the development of life-threatening arrhythmias.

During clinical examination, there is no cardiac hump, percussion reveals no dilated borders of relative cardiac dullness, since the heart remains unenlarged, developing left ventricular myocardial hypertrophy reduces the chamber volume, and dilation does not occur over a long period of time. Palpation reveals systolic tremor in the second intercostal space on the right (with valvular and supravalvular stenosis) or in the third or fourth intercostal space on the left (with subvalvular stenosis). Auscultation reveals a rough systolic murmur at the same points.

Diagnosis of aortic stenosis

Electrocardiography reveals signs of left ventricular overload and subendocardial ischemia of its myocardium (downward displacement of the terminal part of the ventricular complex in the left chest leads).

Radiological signs of aortic stenosis: the apex of the heart is rounded and raised above the diaphragm, forming an acute angle with it.

When scanning the heart, attention is paid to the diameter of the aortic valve ring, the number of valve cusps, their opening, and the diameter of the effective opening. A characteristic echocardiographic symptom is an arcuate bulging of the cusps into the lumen of the aorta with turbulent blood flow through the valve. Doppler echocardiography gives an idea of the level of maximum obstruction and allows an approximate assessment of the severity of stenosis. In addition, left ventricular hypertrophy, its systolic and diastolic parameters are assessed.

Cardiac catheterization and angiocardiography are used in the study of concomitant pathology or in combination with balloon valvuloplasty of valve stenosis.

Differential diagnostics are carried out with atrial and ventricular septal defects due to similar localization of systolic murmur, and with hypertrophic cardiomyopathy - idiopathic hypertrophic subaortic stenosis.

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Treatment of aortic stenosis

Palliative surgical treatment of aortic stenosis - valvotomy through transaortic access. The operation is indicated in syncopal conditions, pressure gradient between the aorta and the left ventricle more than 50 mm Hg.