Stenosis Aorta

Stenosis Aorta

Pembimbing dr. Aminah, Sp.JP

Oleh:- Anaytullah- Rahmanandhika S

¼ dari seluruh pasien penyakit jantung valvular kronik

Sekitar 80% dari pasien dewasa yang simptomatik adalah laki-laki

Ukuran normal orificium aorta 2-3 cm2

Pendahuluan

Epidemiology Sklerosis aorta- precursor dari stenosis,

ditemukan 30% pada >65 years. Prevalensi Stenosis Aorta:

2% of people over the age of 65 3% of people over age 75 4% percent of people over age 85 have the

disorder Penyebab stenosis aorta:

Congenital- unicuspid, bicuspid Bicuspid aortic valve present in 2% of population More common in males 30% of people with bicuspid valve will develop

complications Most common cause of aortic valve replacement up to

age 70 is bicuspid valve can be associated with other syndromes: Coarctation,

Turner syndrome, PDA Acquired- Rheumatic, senile (calcific)

Causes of Aortic Stenosis congenital (1-30yrs old) bicuspid (40-60yrs old) rheumatic (40-60yrs old) senile degenerative (>70yrs old)

Patology

Aortic Stenosis

Aortic Stenosis

AORTIC STENOSIS

Normal aortic valve area 2.5-3.5 cm2

Mild Aortic Stenosis=1.5-2.5 cm2 Moderate Stenosis=1.0-1.5 cm2 Severe Aortic Stenosis=<1.0 cm2 Critical Aortic Stenosis=<0.8 cm2

Systolic Pressure Gradient Across AV : Mild AS → < 35 mmHg.

Mod AS → 35 - 50 mmHg. Severe AS → > 50 mmHg.

RA LA

RV LV

VCS dan VCI v.pulmonalis

Aortaa.pulmonalis

Aortic Stenosis – pathophysiology

Aortic Stenosis

Physical Exam

Harsh Systolic Ejection Murmur – late peaking S4 gallop (from LVH) Sustained Bifid LV impulse (from LVH) Pulsus Parvus et Tardus (Carotid Impulse)

AORTIC STENOSIS

DIAGNOSIS: Symptoms Physical exam Chest X-Ray EKG Echo-major diagnostic tool and means of follow-up. Allows measurement of gradient, LV function, associated

lesions

Aortic StenosisEKG

Hypertrophy (LVH)

RontgenCardiomegaly Kalsifikasi katup aorta (foto

lateral)

ECHOConfirm, Severity

AS Treatment• Asimtomatik : tidak ada• pulmonary congestion : digitalis,

diuretics, and angiotensin-converting enzyme (ACE) inhibitors

• predominant symptom is angina : beta-blockers

• Vasodilators : heart failure and hypertension

Statin dianjurkan untuk mencegah kalsifikasi katup aorta

Indikasi operasi : area katup < 1 cm2 atau 0,6cm/m2, disfungsi LV.

• Begitu gejala muncul, rata-rata hanya 25 % yang bertahan hidup 3 tahun

• Pasien dengan angina hanya 50% bertahan hidup 5 tahun

• Pasien dengan sinkop hanya 50% bertahan hidup 3 tahun

• Pasien dengan gagal jantung hanya 50% bertahan hidup 2 tahun

• Risiko mati mendadak pada pasien asimtomatik 2%• Survival rate 10 tahun pasca operasi katup aorta

sekitar 60%.

Prognosis