Congenital Aortic Stenosis

Question 1

Describe the appearance of the cusps in a patient with Congenital Aortic stenosis:

Answer 1

The cusps are fused and may or may not be thickened.

Cusps can become calcific later in life.

Question 2

True or false: Congenital AS is life threatening and requires prompt treatment.

Answer 2

False; Congenital AS can be well tolerated if there are no symptoms.

Question 3

What steps are taken for a patient with congenital AS after the age of 6 years?

Answer 3

A stress echo should be done to evaluate exercise tolerance and watch for any evidence of arrhythmia or other abnormal response.

Question 4

Name three things patients with congenital aortic stenosis are monitored for:

Answer 4

Monitor LV shape, size and overall function
Evidence of LV failure
Evidence of PHTN

Question 5

Name two things patients with congenital aortic stenosis are at risk for:

Answer 5

Severe ventricular arrhythmias

SBE: subacute bacterial endocarditis

Question 6

Name 7 physical symptoms and findings associated with congenital aortic stenosis:

Answer 6

1) Fatigue 2) CHF, chest pain 3) Arrhythmias 4) Dyspnea (SOB) 5) Murmur (crescendo/decrescendo) 6) Evidence of Lt heart failure 7) Dilated aortic root

Question 7

What is post-stenotic aortic dilatation?

Answer 7

A dilatation of the aortic root distal to the stenotic valve as a result of the high pressure and high velocity jet produced.

Question 8

How does congenital AS affect the sinuses of valsalva?

Answer 8

It decreases the sinuses of valsalva area which results in a decrease in coronary reserve.

Question 9

Congenital AS increases stress in the walls of the aorta, leaving patients at risk for what?

Answer 9

Aneurysm and aortic dissection

Question 10

Is surgery always needed for patients with congenital AS?

Answer 10

Need for surgery depends on the age of the patient and the degree of the AS.

Question 11

Name some surgical options and treatment for congenital AS:

Answer 11

1) Balloon valvuloplasty 2) Valve replacement 3) Ross procedure 4) Drug management and therapy

Question 12

What is the Ross Procedure?

Answer 12

A surgery where the patient’s diseased aortic valve is replaced with his or her own pulmonary valve. The pulmonary valve is not usually replaced, it is left open.

Question 13

Describe some symptoms of left heart failure due to AS:

Answer 13

Pulmonary infiltrates, peripheral edema, distended neck veins, high BP, increased heart rate