Pathophysiology

The left Herzkammer (ventricle, see heart) pumps blood with each heart impact by the Aortenklappe to the chest artery (Aorta). The opening surface of a healthy Aortenklappe with the adult amounts to about 3,0 - 4,0 cm A narrowing of the Aortenklappe leads to the fact that increasingly higher pressure must be produced, in order to promote the same quantity of blood. A narrowing on approximately 25% of the normal opening surface leads to an important pressure load of the left ventricle. A heavy Aortenklappenstenose, by which symptoms can be expected, has usually an opening surface of less than 0,75 - 1,0 cm During the flap opening a middle pressure gradient between between left ventricle and Aorta of more than 50 mmHg then usually already exist.

Natural process and symptoms

Since the flap narrowing increases usually only slowly or remains unchanged, the heart can adapt to the increased pressure load of the left ventricle by a Verdickung of the heart muscle (Hypertrophie). Thus the flap error remains often over years and decades asymptomatisch.

The occurrence of the typical symptoms however is considered as serious warning reference:

• A feeling of the chest tightness (angina pectoris), first usually during physical load, points on a lack supply of the pressure-loaded hypertrophierten heart muscle. The middle life expectancy amounts to then still approx. 5 years.
• Sudden unconsciousness (Synkope), likewise usually arising during load, shows that the left ventricle cannot promote the increased blood need no more by the stenosierte Aortenklappe. The middle survival period is years shortened on approx. 3.
• An acute heart insufficiency with lung congestion or pulmonary edema refers to the beginning of a critical phase with no longer sufficient reserves of the heart muscle. The middle life expectancy is reduced with approx. 2 years then clearly.

The prognosis of a asymptomatischen, usually coincidentally discovered Aortenklappenstenose is first only uncertainly to be predicted. The flap opening surface decreases annually on the average by approximately 0,12 cm however shows up with more than half of the patients over years no or only a very small degradation. Reference points for a forecast can supply the extent of the flap calcifying and in particular the process in the first years.

Diagnostics

The simplest investigation with the suspicion on a Aortenstenose is the Abhorchen with the Stethoskop (Auskultation). Typical noise findings of the Aortenstenose are a systolic heart noise (Systolikum), which is loudest over the Aortenareal (direct on the right of the upper breastbone third) and is away-led into the carotid arteries.

With suspicious noise findings an ultrasonic investigation of the heart (Echokardiografie) is accomplished, with whose assistance the Aortenklappe can be judged usually reliably. With sufficiently good sound conditions the Aortenstenose can be quantified already reliably, as by means of doppler technology the pressure gradients and the flap opening surface are computed.

With operation-needy patients a heart catheter investigation inclusive Koronarangiografie will nearly always take place, in order to exclude before the heart surgery an accompanying koronare heart illness, which would require otherwise a simultaneous bypass operation. With unclear Echokardiografiebefunden also the accurate extent of the Aortenstenose can be determined during the heart catheter investigation.

Therapy

Symptomatic acquired Aortenklappenstenosen must be treated usually operationally. The flap gotten sick is removed and replaced by a biological or artificial flap prosthesis. This operation becomes also with very old humans (to over 90. Lebensjahr outside) accomplished, because also with them the prognosis can be improved by an operation. In the 90's 20. Century large hopes had been set into the technically feasible Ballondilatation of the Aortenklappe over a heart catheter, which could save the patient the heart surgery. Today however this method is limited to patients with a very high operation risk, since after successful Dilatation usually very fast a narrowing resets itself.

A asymptomatische Aortenklappenstenose usually requires no special therapy, should be controlled however regularly kardiologisch. If due to the process observation it is to be assumed that a heavy Aortenstenose becomes symptomatic shortly, can be guessed already at this time to the operation.

The attempt to stop the progressive narrowing of kalzifizierter Aortenstenosen by Statine cannot be evaluated due to contradictory study results yet finally.

With medical and dental interferences, which can lead to an a washing of bacteria into the Blutkreislauf , must be accomplished a Endokarditisprophylaxe with antibiotics.

Articles in category "Acquired Aortenklappenstenose"

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