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Stenosis of the aorta: symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Stenosis of the aorta is a vice, characterized by a narrowing of the valvular, subvalved or supra-valvular aperture. When stenosis develops myocardial hypertrophy of the left ventricle with a decrease in its cavity, since the myocardium of the left ventricle works with increased strain due to an obstruction to the discharge of blood into the aorta.
[Symptoms of aortic stenosis
At an early age, most children do not complain, develop well. After the relative "well-being" there are complaints of anginal pain in the heart, periodic dyspnea, fainting. Fainting (syncopal conditions) is a sign of severe aortic stenosis with a pressure gradient between the aorta and the left ventricle of more than 50 mm Hg. To a short-term loss of consciousness leads to a decrease in cardiac output. With aortic stenosis, there is a risk of sudden cardiac death, since myocardial hypertrophy is the background for the development of acute coronary insufficiency, especially under physical stress. The same factor can lead to the development of life-threatening arrhythmias.
With a clinical examination, the cardiac hump is absent, percutaneously the boundaries of relative cardiac dullness are not expanded, since the heart remains unimportant, developing left ventricular myocardial hypertrophy reduces the chamber volume, dilation does not occur for a long time. Palpatorically, systolic jitter is detected in the second right intercostal space (with valvular and nadklapannom stenosis) or in the third to fourth intercostal space on the left (with valvular stenosis). At the same points, auscultation is detected by gross systolic noise.
Diagnosis of aortic stenosis
Electrocardiographically, signs of left ventricular overload and subendocardial ischemia of myocardium are revealed (displacement of the end part of the ventricular complex downward in the left thoracic leads).
X-ray signs of aortic stenosis: the apex of the heart is rounded and raised above the diaphragm, forming an acute angle with it.
When scanning the heart, pay attention to the diameter of the valve ring of the aorta, the number of valve sockets, their opening, the diameter of the effective hole. A characteristic echocardiographic symptom is the arcuate swelling of the valves into the aortic lumen with a turbulent flow of blood through the valve. Doppler echocardiography gives an idea of the level of maximum obstruction and allows an approximate assessment of the severity of stenosis. Additionally, hypertrophy of the left ventricle, its systolic and diastolic parameters are evaluated.
Cardiac catheterization and angiocardiography are used in the study of concomitant pathology or in combination with balloon valvuloplasty of valvular stenosis.
Differential diagnosis is performed with a defect of the interatrial and interventricular septum due to a similar localization of systolic noise, with hypertrophic cardiomyopathy - idiopathic hypertrophic subaortic stenosis.
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Treatment of aortic stenosis
Palliative surgical treatment of aortic stenosis - valvulotomy through transaorthal access. The operation is indicated for syncopal conditions, the pressure gradient between the aorta and the left ventricle is more than 50 mm. Hg.