Aortic valve stenosis

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Chen Qiling

(Chief Physician) Review

Heart Center of Peking University People's Hospital

Aortic valve Stenosis is mainly caused by rheumatic fever sequela Congenital aortic valve Structural anomaly Or senile Aortic valve calcification Caused by. The patients may be asymptomatic in the compensatory period, and most patients with severe stenosis of valve orifice are tired dyspnea (laborious or paroxysmal) angina pectoris 、 vertigo or syncope , even sudden death.

Foreign name: aortic valve stenosis
Visiting department: Internal Medicine-Cardiovascular Department
Common causes: It should be caused by the sequela of rheumatic fever, congenital aortic valve structural abnormality or senile aortic valve calcification

common symptom: Angina pectoris, dizziness or syncope, dyspnea, sudden death, hyperhidrosis and palpitation
Chinese name: Aortic valve stenosis

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pathogeny

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Mainly caused by rheumatic fever sequela Congenital aortic valve Structural anomaly Or senile aortic valve calcification. Because the outlet of the left ventricular outflow tract is Active pulse orifice , adult Aortic valve orifice area ≥3.0cm two When the area of aortic valve orifice is reduced to 1/3 or more of the normal, the blood flow will be blocked.

clinical manifestation

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one angina pectoris

60% of symptomatic patients are often induced by exercise and relieved after rest. It occurs after tiredness or at rest, indicating that it is related to tiredness and physical activity Not necessarily relevant. Its mechanism may be caused by myocardial hypertrophy , Myocardium Oxygen demand Increased and secondary to coronary artery Caused by excessive pressure supply oxygen Decrease, left Ventricular systole Ventricular wall Too high tension of

two vertigo Or syncope

About 30% of patients have vertigo Or syncope occurs, and the duration can be as short as 1 minute to more than half an hour. Some patients are accompanied by A-S syndrome or Arrhythmia 。 vertigo Or syncope often occurs after labor or when the body bends forward, sometimes Resting state , sudden change of posture or Sublingual clothing glyceryl trinitrate treatment angina pectoris Time induced. Its mechanism is still unclear, which may be related to the following factors: ① Labor makes the surrounding areas Vasodilation The narrow aortic orifice restricts the cardiac output capacity to increase accordingly, resulting in Cerebral insufficiency 。② Transient severe Arrhythmia , resulting in Hemodynamics ③ Carotid sinus allergy 。

three dyspnea

Exertional dyspnea It is often the manifestation of cardiac insufficiency, often accompanied by fatigue and weakness. along with heart failure Can occur Paroxysmal dyspnea at night 、 Sitting upright breathing , cough Pink foam sputum 。

four sudden death

It accounts for 10%~20%. Most cases often have repeated deaths before sudden death angina pectoris Or syncope, but it can also be the first symptom. Its causes may be serious and fatal Arrhythmia , such as ventricular fibrillation.

five hyperhidrosis and palpitation

This kind of patient sweats much because Myocardial contraction Enhancement and Arrhythmia Patients often feel palpitations, and hyperhidrosis often occurs after palpitations, which may be related to autonomic nervous dysfunction, sympathetic nerve Increased tension.

inspect

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one X-ray inspect

Normal heart shadow or Left ventricle Slight increase, left atrium May increase slightly, Ascending aorta The root is often dilated after stenosis. stay Lateral position Aortic valve calcification can be seen under fluoroscopy. In late stage Pulmonary congestion sign 。

two ECG examination

Severe stenosis with left ventricular hypertrophy and ST-T secondary Change and enlargement of left atrium. There may be atrioventricular block, intraventricular block (left bundle branch block or Left anterior branch block ）, atrial fibrillation or ventricular Arrhythmia 。

three Echocardiography inspect

It is an important method for clear diagnosis and determination of stenosis degree. Type M is insensitive and lacking in diagnosis of the disease Specificity 。 Two dimensional echocardiography is sensitive and can provide Cardiac cavity Size Left ventricle Hypertrophy and function.

4. Left Cardiac catheterization

When echocardiography cannot determine the degree of stenosis and consider artificial valve replacement Cardiac catheterization should be performed. The most common method is to measure the left ventricle and aorta Pressure, or use a single lumen catheter to slowly withdraw from the left ventricle to the aorta to continuously record the pressure curve; If the left cardiac catheter is difficult to pass through the stenosis Aortic valve The right cardiac catheter can be used to puncture through the right heart Interventricular septum Enter the left ventricle and measure the pressure synchronously with the intra aortic catheter. Calculate left ventricle aorta Systole Peak pressure difference, according to the obtained pressure difference, the valve orifice area can be calculated.> 1.0cm two Mild stenosis, 0.75~1.0cm two Moderate stenosis,<0.75CM two Severe stenosis. If judged by differential pressure, the mean differential pressure>50mmHg or peak differential pressure up to 70mmHg is severe stenosis.

diagnosis

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According to clinical symptoms, check the ejection of aortic valve area at the bottom of heart Systolic murmur Echocardiography confirmed the stenosis of aortic valve, which can be definitely diagnosed.

treatment

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1. Mild stenosis without symptoms, no treatment, but regular reexamination is required

As always syncope 、 angina pectoris . Symptoms such as left ventricular dysfunction are considered to be severe stenosis, and the effect of medical treatment is not obvious. Intervention or surgical treatment 。

2. Aorta Valvoplasty

main Indications ① Congenital nature of children and youth Aortic stenosis ；② Severe aortic stenosis Cardiogenic shock Those who cannot tolerate surgery; ③ Severe stenosis endangers life, and heart failure Transition with high surgical risk Treatment measures ；④ Pregnant women with severe aortic stenosis; ⑤ Rejection of operation for severe aortic stenosis.

3. Valve replacement treatment

The technique of aortic valve disease is very mature, and the success rate of operation is more than 98%, and the effect is good. The main indications are ① syncope or angina pectoris Medical history; ② electrocardiogram Left ventricular hypertrophy ；③ Cardiac function grade III-IV; ④ Left Ventricular Aortic Intervals Pressure step difference >6.65kPa（50mmHg）。

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