Bicuspid Aortic Valves Flashcards
Name 7 characteristics of Eisenmenger’s Complex.
1) Large VSD 2) Overriding Aorta 3) NO RVOT obstruction 4) PA can be dilated 5) TV is abnormal 6) Increased pulmonary vascular resistance 7) Shunt reversal leading to Eisenmenger’s physiology
Evolution of Eisenmenger’s Complex:
1) ASD, VSD, or complex defect. Lt to Rt shunting with increase in RV pressure, increase in pulmonary artery pressure.
2) Over time, increase in pulmonary vascular resistance, resulting in bidirectional flow.
3) PVR increases; shunt reverses to Rt to Lt (Eisenmenger’s syndrome); increasingly cyanotic.
Why are bicuspid aortic valves sometimes an incidental finding?
If the valve is not stenotic or regurgitant, they can go undetected.
These valves are usually more regurgitant than stenotic.
Which patients are more likely to have a bicuspid aortic valve?
More common in male patients. About 2:1.
Describe some characteristics of a bicuspid aortic valve:
There are 2 cusps of unequal size.
The anterior cusp is usually larger and has a ridge called a raphe.
Valve may be stenotic with varying degrees of AI.
Besides having only two cusps, name some other characteristics associated with a bicuspid aortic valve:
Often there is a coarctation of the descending Ao.
The coronary arteries may be too short, or have other abnormalities.
How will a bicuspid aortic valve affect the LV over time?
Volume in the LV will begin to increase. The LV will begin to dilate and thicken. LV function will decrease.
Name some physical signs and symptoms of a bicuspid aortic valve:
Evidence of a murmur: either AS or AI.
Evidence of LV impact.
Evidence of CHF.
Systemic, and or, Pulmonary hypertension.
True or false: AS affects preload.
False. AS affects afterload. The LV must work against the stenotic valve, which increases afterload.
Name some interventions that may be used to treat bicuspid aortic valve:
Surgery for a critical AS or AI, and repair the coarct.
Aortic balloon valvuloplasty if the valve is stenotic.
Patients in their 20’s may have a tissue valve replacement.
What steps may be taken if a child is diagnosed with bicuspid aortic valve?
The child will be monitored closely, paying attention to the LV size and function, and watching for any evidence of PHTN.
Child may have an echo study every 6 months.
What physiologic changes occur due to a coarctation of the descending Ao?
There will be high BP before the point of coarctation.
Low BP beyond the point of coarctation.
Arms will have high BP, while legs will have low BP.
Kidneys respond by increasing systemic BP.
In patients with symptomatic bicuspid aortic valves, what conduction changes are they at risk for?
Ventricular arrhythmias: PVC’s, V-fib, V-tach
Coarctations mimic ____ ____, which increases ______.
Aortic stenosis
Afterload
What surgical measures might be taken for a coarctation of the descending Ao?
If it is a small coarctation, that section will be cut out and the two ends sewn back together.
If it is a large coarct, a graft will be used.
