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

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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
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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)
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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

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5
Q

What is pulmonary stenosis?

A
  • Where the pulmonary valve leaflets are partial fused together giving resticted exit from the right ventricle
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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)
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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)
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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
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