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{{Template:Aortic stenosis}}
{{Aortic stenosis}}
{{CMG}}
{{CMG}}; '''Associate Editors-In-Chief:''' Claudia P. Hochberg, M.D. [mailto:chochber@bidmc.harvard.edu], [[User:Abdarabi|Abdul-Rahman Arabi, M.D.]] [mailto:abdarabi@yahoo.com], [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu], [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh13579@gmail.com], {{AA}}; '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu]
 
==Overview==
Gross anatomy dissection may be used as a diagnostic tool in the evaluation of aortic stenosis. Common findings associated with aortic stenosis include [[left ventricular hypertrophy]] and [[heart block]].


==Pathological Findings==
==Pathological Findings==
Pathological findings of congenital or acquired aortic stenosis in adults results in thickening and calcification of aortic valve. Following patterns may be seen:<ref name="pmid3402479">{{cite journal| author=Normand J, Loire R, Zambartas C| title=The anatomical aspects of adult aortic stenosis. | journal=Eur Heart J | year= 1988 | volume= 9 Suppl E | issue=  | pages= 31-6 | pmid=3402479 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3402479  }} </ref>
*Calcified bicuspid valve involving anterior or posterior cusps
*Calcified aortic valve cusps with fusion of commissures seen in post rheumatic cases
*Degenerative calcific aortic stenosis which shows sinuses of valsalva filled with calcium deposits seen in age >70
Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology]
Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission. [http://www.peir.net © PEIR, University of Alabama at Birmingham, Department of Pathology]
 
<gallery>
<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve1.jpg|Aortic Stenosis, Bicuspid valve: Gross; excellent image of bicuspid and calcific valve showing a false raphe.
Image:Bicuspid aortic valve1.jpg|Aortic Stenosis, Bicuspid valve: Gross; excellent image of bicuspid and calcific valve showing a false raphe.
Image:Bicuspid aortic valve2.jpg|Aortic Stenosis, Bicuspid valve: Gross; good example of bicuspid valve
Image:Bicuspid aortic valve2.jpg|Aortic Stenosis, Bicuspid valve: Gross; good example of bicuspid valve
</gallery>
</div>


<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve3.jpg|Aortic Stenosis, Bicuspid valve: Gross; image of bicuspid aortic valve, an excellent example
Image:Bicuspid aortic valve3.jpg|Aortic Stenosis, Bicuspid valve: Gross; image of bicuspid aortic valve, an excellent example
Image:Bicuspid aortic valve4.jpg|Aortic Stenosis, Bicuspid valve: Gross; close-up image of bicuspid aortic valve.
Image:Bicuspid aortic valve4.jpg|Aortic Stenosis, Bicuspid valve: Gross; close-up image of bicuspid aortic valve.
</gallery>
</div>


<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve5.jpg|Aortic Stenosis, Bicuspid valve: Gross; close-up image of bicuspid aortic valve.
Image:Bicuspid aortic valve5.jpg|Aortic Stenosis, Bicuspid valve: Gross; close-up image of bicuspid aortic valve.
Image:Bicuspid aortic valve6.jpg|Bicuspid aortic valve
Image:Bicuspid aortic valve6.jpg|Bicuspid aortic valve
</gallery>
</div>


<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve7.jpg|Gross natural color opened first portion aortic arch with bicuspid aortic valve shows stenosis and aortic root is dilated
Image:Bicuspid aortic valve7.jpg|Gross natural color opened first portion aortic arch with bicuspid aortic valve shows stenosis and aortic root is dilated
Image:Bicuspid aortic valve8.jpg|Aortic Stenosis Bicuspid: Gross; natural color opened left ventricular outflow tract with calcific masses on valve as well as anterior leaflet mitral valve probably did not cause significant stenosis
Image:Bicuspid aortic valve8.jpg|Aortic Stenosis Bicuspid: Gross; natural color opened left ventricular outflow tract with calcific masses on valve as well as anterior leaflet mitral valve probably did not cause significant stenosis
</gallery>
</div>


<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve9.jpg|Bicuspid Aortic Valve with Repaired Aorta Coarctation: Gross natural color opened left ventricular outflow tract with uncomplicated bicuspid aortic valve repaired coarctation barely visible ruptured postoperative young female with ovaries Turner mosaic not ruled out
Image:Bicuspid aortic valve9.jpg|Bicuspid Aortic Valve with Repaired Aorta Coarctation: Gross natural color opened left ventricular outflow tract with uncomplicated bicuspid aortic valve repaired coarctation barely visible ruptured postoperative young female with ovaries Turner mosaic not ruled out
Image:Bicuspid aortic valve10.jpg|Bicuspid Aortic Stenosis: Gross; fixed tissue
Image:Bicuspid aortic valve10.jpg|Bicuspid Aortic Stenosis: Gross; fixed tissue
</gallery>
</div>


<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve11.jpg|Aortic Stenosis, Bicuspid: Gross; fixed tissue view of stenotic valve through ventricular outlet track  
Image:Bicuspid aortic valve11.jpg|Aortic Stenosis, Bicuspid: Gross; fixed tissue view of stenotic valve through ventricular outlet track  
Image:Bicuspid aortic valve12.jpg|Aortic Stenosis Bicuspid: Gross; fixed tissue. Bicuspid valve and false raphe classical
Image:Bicuspid aortic valve12.jpg|Aortic Stenosis Bicuspid: Gross; fixed tissue. Bicuspid valve and false raphe classical
</gallery>
</div>


<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve13.jpg|Bicuspid aortic valve
Image:Bicuspid aortic valve13.jpg|Bicuspid aortic valve
Image:Bicuspid aortic valve14.jpg|Bicuspid aortic valve
Image:Bicuspid aortic valve14.jpg|Bicuspid aortic valve
</gallery>
</div>


<div align="left">
<gallery heights="150" widths="150">
Image:Bicuspid aortic valve15.jpg|Bicuspid aortic valve
Image:Bicuspid aortic valve15.jpg|Bicuspid aortic valve
Image:Bicuspid aortic valve16.jpg|Left ventricular hypertrophy due to bicuspid aortic valve
Image:Bicuspid aortic valve16.jpg|Left ventricular hypertrophy due to bicuspid aortic valve
</gallery>
</div>


<div align="left">
<gallery heights="150" widths="150">
Image:Congenital aortic stenosis.jpg|Congenital aortic stenosis: Gangrene toe In Infant: Gross, natural color, 1 month old child with congenital aortic stenosis   
Image:Congenital aortic stenosis.jpg|Congenital aortic stenosis: Gangrene toe In Infant: Gross, natural color, 1 month old child with congenital aortic stenosis   
Image:Unicuspid aortic stenosis.jpg|Unicuspid aortic stenosis
Image:Unicuspid aortic stenosis.jpg|Unicuspid aortic stenosis
</gallery>
</gallery>
</div>
==An Autopsy Report==
A 68-year-old man initially sought medical advice five years prior to his death. His symptoms at that time were [[exercise intolerance]] and occasional [[peripheral edema]]. He gave a history of a "[[heart murmur]]" that was diagnosed 25 years ago during an employment physical. No follow up care had been given for this murmur.
The patient's terminal admission was for signs of severe [[heart failure]]--the patient had marked [[peripheral edema]] and [[shortness of breath]] and [[chest x-ray]] revealed significant cardiac enlargement and [[pulmonary edema]] with bilateral [[pleural effusion]]s. He sustained a [[cardiac arrest]] shortly after admission and could not be resuscitated.
===Autopsy Findings===
Autopsy disclosed a markedly enlarged heart weighing 650 grams and having dilated chambers. The aortic valve was calcified and showed evidence of stenosis and insufficiency. The coronary arteries were narrowed 60 to 70% by atherosclerosis. No acute coronary occlusions were found and there was no evidence of [[myocardial infarction]].
<div align="left">
<gallery heights="150" widths="150">
Image:Comparison of hypertrophic myocardium and normal Gross.JPG|This is a gross photograph of a cross section of a normal human heart taken at autopsy (right) and the heart from this case, which demonstrates concentric hypertrophy of the left ventricular wall. Note the marked thickening of the left ventricular wall. There is also moderate thickening of the right ventricular wall.
Image:Comparison of hypertrophy and normal myocardial micro 1.JPG|This low-power photomicrograph shows normal myocardium (left) compared to hypertrophied myocardium (right).
</gallery>
</div>
<div align="left">
<gallery heights="150" widths="150">
Image:Comparison of hypertrophy and normal myocardial micro 2.JPG|Normal myocardium (left) is compared here to hypertrophied myocardium (right). The muscle fibers are thicker and the nuclei are larger and darker in the hypertrophied myocardium.The clear spaces between the muscle fibers are due to processing artifacts and are not present during life.
Image:Comparison of hypertrophy and normal myocardial micro 3.JPG|Normal myocardium (left) is compared to hypertrophied myocardium (right). This high power view demonstrates the large dark nuclei (arrow) found in hypertrophied cardiac muscle cells. Polyploidy is a common feature in cardiac hypertrophy. Also note the increased size (thickness) of the individual cardiac muscle cell on the right compared to normal cardiac myocytes (left).
</gallery>
</div>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{Circulatory system pathology}}
{{Congenital malformations and deformations of circulatory system}}
[[Category:DiseaseState]]
[[Category:Signs and symptoms]]
[[Category:Physical Examination]]
[[Category:Valvular heart disease]]
[[Category:Cardiology]]
[[Category:Congenital heart disease]]
[[de:Aortenstenose (angeboren)]]
[[es:Estenosis aórtica]]
[[es:Estenosis aórtica]]
[[fr:Rétrécissement aortique]]
[[fr:Rétrécissement aortique]]
[[no:Aortastenose]]
[[nn:Aortastenose]]
[[pl:Stenoza Aortalnej]]
[[pl:Stenoza Aortalnej]]
[[pt:Estenose aórtica]]
[[pt:Estenose aórtica]]
[[ro:Stenoza Aortică]]
[[ro:Stenoza Aortică]]
[[sv:Aortastenos]]
[[tr:Aort darlığı]]
[[tr:Aort darlığı]]


{{WH}}
{{WH}}
{{WS}}
[[CME Category::Cardiology]]


{{WS}}
[[Category:Disease]]
[[Category:Valvular heart disease]]
[[Category:Cardiology]]
[[Category:Congenital heart disease]]
[[Category:Mature chapter]]
[[Category:Cardiac surgery]]
[[Category:Surgery]]
[[Category:Overview complete]]
[[Category:Template complete]]

Latest revision as of 20:44, 23 December 2016

Aortic Stenosis Microchapters

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Patient Information

Overview

Historical Perspective

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Pathophysiology

Causes

Differentiating Aortic Stenosis from other Diseases

Epidemiology and Demographics

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Diagnosis

History and Symptoms

Physical Examination

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Echocardiography

Cardiac Catheterization

Aortic Valve Area

Aortic Valve Area Calculation

Treatment

General Approach

Medical Therapy

Surgery

Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty

Transcatheter Aortic Valve Replacement (TAVR)

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Evaluation
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Post TAVR management
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Claudia P. Hochberg, M.D. [2], Abdul-Rahman Arabi, M.D. [3], Keri Shafer, M.D. [4], Priyamvada Singh, MBBS [5], Aysha Anwar, M.B.B.S[6]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [7]

Overview

Gross anatomy dissection may be used as a diagnostic tool in the evaluation of aortic stenosis. Common findings associated with aortic stenosis include left ventricular hypertrophy and heart block.

Pathological Findings

Pathological findings of congenital or acquired aortic stenosis in adults results in thickening and calcification of aortic valve. Following patterns may be seen:[1]

  • Calcified bicuspid valve involving anterior or posterior cusps
  • Calcified aortic valve cusps with fusion of commissures seen in post rheumatic cases
  • Degenerative calcific aortic stenosis which shows sinuses of valsalva filled with calcium deposits seen in age >70

Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission. © PEIR, University of Alabama at Birmingham, Department of Pathology

  • Aortic Stenosis, Bicuspid valve: Gross; excellent image of bicuspid and calcific valve showing a false raphe.

    Aortic Stenosis, Bicuspid valve: Gross; excellent image of bicuspid and calcific valve showing a false raphe.

  • Aortic Stenosis, Bicuspid valve: Gross; good example of bicuspid valve

    Aortic Stenosis, Bicuspid valve: Gross; good example of bicuspid valve

  • Aortic Stenosis, Bicuspid valve: Gross; image of bicuspid aortic valve, an excellent example

    Aortic Stenosis, Bicuspid valve: Gross; image of bicuspid aortic valve, an excellent example

  • Aortic Stenosis, Bicuspid valve: Gross; close-up image of bicuspid aortic valve.

    Aortic Stenosis, Bicuspid valve: Gross; close-up image of bicuspid aortic valve.

  • Aortic Stenosis, Bicuspid valve: Gross; close-up image of bicuspid aortic valve.

    Aortic Stenosis, Bicuspid valve: Gross; close-up image of bicuspid aortic valve.

  • Bicuspid aortic valve

    Bicuspid aortic valve

  • Gross natural color opened first portion aortic arch with bicuspid aortic valve shows stenosis and aortic root is dilated

    Gross natural color opened first portion aortic arch with bicuspid aortic valve shows stenosis and aortic root is dilated

  • Aortic Stenosis Bicuspid: Gross; natural color opened left ventricular outflow tract with calcific masses on valve as well as anterior leaflet mitral valve probably did not cause significant stenosis

    Aortic Stenosis Bicuspid: Gross; natural color opened left ventricular outflow tract with calcific masses on valve as well as anterior leaflet mitral valve probably did not cause significant stenosis

  • Bicuspid Aortic Valve with Repaired Aorta Coarctation: Gross natural color opened left ventricular outflow tract with uncomplicated bicuspid aortic valve repaired coarctation barely visible ruptured postoperative young female with ovaries Turner mosaic not ruled out

    Bicuspid Aortic Valve with Repaired Aorta Coarctation: Gross natural color opened left ventricular outflow tract with uncomplicated bicuspid aortic valve repaired coarctation barely visible ruptured postoperative young female with ovaries Turner mosaic not ruled out

  • Bicuspid Aortic Stenosis: Gross; fixed tissue

    Bicuspid Aortic Stenosis: Gross; fixed tissue

  • Aortic Stenosis, Bicuspid: Gross; fixed tissue view of stenotic valve through ventricular outlet track

    Aortic Stenosis, Bicuspid: Gross; fixed tissue view of stenotic valve through ventricular outlet track

  • Aortic Stenosis Bicuspid: Gross; fixed tissue. Bicuspid valve and false raphe classical

    Aortic Stenosis Bicuspid: Gross; fixed tissue. Bicuspid valve and false raphe classical

  • Bicuspid aortic valve

    Bicuspid aortic valve

  • Bicuspid aortic valve

    Bicuspid aortic valve

  • Bicuspid aortic valve

    Bicuspid aortic valve

  • Left ventricular hypertrophy due to bicuspid aortic valve

    Left ventricular hypertrophy due to bicuspid aortic valve

  • Congenital aortic stenosis: Gangrene toe In Infant: Gross, natural color, 1 month old child with congenital aortic stenosis

    Congenital aortic stenosis: Gangrene toe In Infant: Gross, natural color, 1 month old child with congenital aortic stenosis

  • Unicuspid aortic stenosis

    Unicuspid aortic stenosis

References

  1. ↑ Normand J, Loire R, Zambartas C (1988). "The anatomical aspects of adult aortic stenosis". Eur Heart J. 9 Suppl E: 31–6. PMID 3402479.

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