Aortic and pulmonary stenosis Flashcards
1
Q
What is aortic stenosis?
A
Where the aortic valve leaflets are partly fused together, giving restrictive exit from the left ventricle.
There may be one to three leaflets
2
Q
What are the clinical features of aortic stenosis?
(signs (5) and symptoms)
A
Symptoms:
- Asymptomatic except in severe stenosis
- Severe stenosis:
- reduced exercise tolerance
- Chest pain or syncope on exertion
Physical signs:
- Small volume and slow rising pulse
- Carotid thrill (always)
- Ejection systolic murmer at ULSE radiating to nect
- Delayed and soft aortic second sound
- Apical ejection click
3
Q
What investigations should you do for suspected AS?
What would they show?
A
Chest x-ray:
- Normal or prominent left ventricle with post-stenotic dilatation of ascending aorta
ECG:
- May show left ventricular hypertrophy (deep s wave in V2 and tall R wave in V6)
- (down going t wave suggests left ventricular strain and severe aortic stenosis)
4
Q
How should you manage AS?
A
- Regular clinical and echo assessment in order to assess when to intervene
- Children with symptoms on exercise (severe AS) will undergo balloon valvotomy
- May require aortic valve replacement if severe
Balloon valvotomy generally safe in older children but more dangerous & difficult in neonates
5
Q
What is pulmonary stenosis?
A
- Where the pulmonary valve leaflets are partial fused together giving resticted exit from the right ventricle
6
Q
Signs and symptoms for PS?
A
Symptoms:
- Most asymptomatic
- Small number of neonates with critical PS have a duct dependent pulmonary circulation and present in first few days of life with cyanosis
Signs:
- An ejection systolic murmer best heard at the ULSE
- Thrill may be present
- Ejection click may be heard at ULSE
- When very severe ventricular heave can be felt (prominent right ventricular impulse)
7
Q
What investigations are required for PS?
What would they should?
A
Chest radiograph:
- Normal or post-stenotic dilation of the pulmonary artery
ECG:
- Evidence of right ventricular hypertrophy (upright T wave in V1)
8
Q
How should PS be managed?
A
- Most children asymptomatic
- Intervention required when pressure gradient across pulmonary valve become markedly increased (>64mmHg):
- Trans-catheter ballon dilatation is the treatment of choice in most children