Aortic Stenosis Types

• Valvular: bicuspid valve

• Subvalvular: Membrane (discrete), Long tunnel, IHSS

Anatomical types of aortic stenosis (Figure 1)

• normal
• valvular stenosis
• supravalvular stenosis
• discrete subaortic stenosis
• IHSS

M:F=4:1

Aortic Stenosis - Clinical Manifestations

• Most are asymptomatic

• Severe cases: CHF, exertional chest pain, syncope

Physical Examination:

• Acyanotic

• Narrow pulse pressure. Higher BP in the right arm than the left in supravalvular AS

• Systolic thrill with murmur at RUSB, suprasternal notch and over the carotid arteries

• Early ejection systolic click with valvular AS

Figure 2: Cardiac findings of aortic valve stenosis. Abnormal sounds are indicated in black. The systolic thrill may be present in areas with dots.

Aortic Stenosis - Investigations

ECG: Normal even in severe cases or LVH with strain

Chest X-ray: Heart size > normal with dilated ascending aorta

Aortic Stenosis - Treatment

• Aortic valve commissurotomy: When peak gradient >50 mmHg or valve area <0.5 cm2/m2

• Membrane excision

• Myectomy - For Tunnel sub aortic stenosis & IHSS

• Fabric patch- Supravalvular