Stenosis Flashcards
Aortic Stenosis (AS)
Cause
Bicuspid fusion types (%)
Calcium severity
1 calcification (tricuspid > 75 y/o) (bicuspid < 65 y/o)
Rheumatic is still a leading cause in developing countries
Fusion;
#1 R-L (80%) creates a large anterior cusp with both coronaries, and small posterior cusp
R-Non (20%) creates a large right cusp compared to left with coronaries arising from each
L-Non, true bicuspid, 2 equal cusps
Ca++
Mild: few areas, little shadowing
Mod: multiple larger areas
Sev: extensive thickening with prominent acoustic shadowing
Note: Ca++ is a predictor of outcome, heart failure, need for replacement and death
AS severity
Level 1 evidence for these 3 measurements
Peak V: < 2.9 / 3-4 / >4
Mean gradient: <20 / 20-40 / >40
AVA (by continuity): >1.5 / 1-1.5 / <1
Mitral Stenosis (MS) Causes
1 Rheumatic
LA myxoma and/or atrial thrombus; MV inflow obstruction acting like stenosis
Severe MAC
Parachute MV; congenital, leaflets anchored to 1 pap muscle leading to restricted opening
Congenital MS
Subvalvular ring
Cor Triatriatum sinister; LA divided by a membrane leading to inflow of obstruction
MS severity
Mean gradient: <5 / 5-10 / > 10
PHT: 90-150 / 151-219 / >220
MVA: 1.6-2.5 / 1-1.5 / < 1
Note: severe MR will increase LAP and increase the MS gradient. Decreased LV compliance will overestimate gradient. For PHT decreased LV compliance and AI will lead to rapid rise in LVEDP, falsely lowering PHT and overestimating the MVA
TS
Etiology
Rare, due to large annulus size
#1 Rheumatic
Carcinoid TR>TS (will also effect PV)
Congenital
TS
severity
Normal peak TV velocity: 30-70 cm/s
Mean gradient > 5mmHg = severe
*gradients are heart rate and flow dependent
- increased HR —> decreased filling time = increased gradient
PS
etiology
Grading
Usually congenital
Measure peak and mean gradients with CWD
Velocity: < 3 / 3-4 / >4
Peak G: <36 / 36-64 / >64
Area: / <0.5
