2 - Paeds - CVS - Aortic Stenosis + Pulmonary Stenosis

Question 1

AS

• how does this happen?
• may be ass w?

Answer 1

aortic leaflets (1-3) partly fused

possibly - mitral valve stenosis + coarctation of aorta

Question 2

AS

Sx? if severe? in neonates?

Answer 2

aSx murmur
if severe -> reduced exercise tolerance, syncope, chest pain
neonates with critical AS + duct dep systemic circulation may show severe HF > shock

Question 3

AS

physical signs?

Answer 3

small vol, slow rising pulse
carotid thrill
EjectionSM at URSternalE radiating to neck
delayed soft aortic HS2
apical ejection click

Question 4

AS

Ix

Answer 4

CXR normal or prominent left ventricle with post stenotic dilatation of ascending aorta
ECG - LVH

Question 5

AS
MGMT - how to monitor?
Why do balloon valvotomy? safest in who? end treatment?

Answer 5

regular Echos to know when to intervene
if Sx on exercise/high resting pressure gradient across AV -> balloon valvotomy
safest in older, dangerous in neonates

most needing Tx will eventually need AV replacement

Question 6

PS

how ? restricts what?

Answer 6

pulm valve leaflets partly fused

restricts bl fl exit from RV

Question 7

Ps - how diagnosed?

Sx? few have what?

Answer 7

clinical diagnosis
most aSx
few with critical PS have duct dependent pulm circulation and present with cyanosis in first few days

Question 8

PS

Physical signs?

Answer 8

ESM at ULSE, ?thrill
Ejection click at ULSE
RV heave if severe

Question 9

PS

Ix?

Answer 9

CXR normal/post stenotic dilatation
ECG RVH (upright T in V1)

Question 10

PS

MGMT

Answer 10

trans catheter balloon dilatation needed when pressure gradient across PV markedly increased (>64mmHg)