Aortic stenosis pathophysiology: Difference between revisions
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In individuals with AS, the left ventricle (LV) has to generate an increased pressure in order to overcome the increased [[afterload]] caused by the stenotic aortic valve and eject blood out of the LV. The more severe the aortic stenosis, the higher the gradient is between the left ventricular systolic pressures and the aortic systolic pressures. Due to the increased pressures generated by the left ventricle, the [[myocardium]] (muscle) of the LV undergoes [[left ventricular hypertrophy|hypertrophy]] (increase in muscle mass). This is seen as thickening of the walls of the LV. The type of hypertrophy most commonly seen in AS is concentric hypertrophy, meaning that all the walls of the LV are (approximately) equally thickened. | In individuals with AS, the left ventricle (LV) has to generate an increased pressure in order to overcome the increased [[afterload]] caused by the stenotic aortic valve and eject blood out of the LV. The more severe the aortic stenosis, the higher the gradient is between the left ventricular systolic pressures and the aortic systolic pressures. Due to the increased pressures generated by the left ventricle, the [[myocardium]] (muscle) of the LV undergoes [[left ventricular hypertrophy|hypertrophy]] (increase in muscle mass). This is seen as thickening of the walls of the LV. The type of hypertrophy most commonly seen in AS is concentric hypertrophy, meaning that all the walls of the LV are (approximately) equally thickened. | ||
In adults with AS, the obstruction develops | In adults with AS, the obstruction develops gradually usually over decades. During this time, the left ventricle adapts to the systolic pressure overload through a hypertrophic process. However, if the hypertrophic process is inadequate and relative wall thickness does not increase in proportion to pressure, wall stress increases and the high afterload causes a decrease in ejection fraction <ref name="pmid3286263">{{cite journal| author=Rydén L| title=Noninvasive techniques in the evaluation of the arrhythmogenic effects. | journal=Eur Heart J | year= 1988 | volume= 9 Suppl B | issue= | pages= 19-23 | pmid=3286263 | doi= | pmc= | url= }} </ref>. Clinically, it is difficult to determine the cause of low ejection fraction whether it is due to depressed contractility or to excessive afterload. Corrective surgery will be more beneficial and will have better outcome when the low ejection fraction is caused by high afterload than when caused by depressed contractility of the myocardium. | ||
==References== | ==References== | ||
Revision as of 17:22, 29 September 2011
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Aortic Stenosis Microchapters |
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Diagnosis |
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Treatment |
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Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty |
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Transcatheter Aortic Valve Replacement (TAVR) |
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Case Studies |
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Aortic stenosis pathophysiology On the Web |
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American Roentgen Ray Society Images of Aortic stenosis pathophysiology |
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Directions to Hospitals Treating Aortic stenosis pathophysiology |
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Risk calculators and risk factors for Aortic stenosis pathophysiology |
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], Mohammed A. Sbeih, M.D. [6]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [7]
Overview
Aortic stenosis results in the onset of a chronic pressure overload of the left ventricle. As the disease progresses, an aortic stenosis can result in compromised functional integrity of the surrounding mitral valve. The most common complication of aortic stenosis is left ventricular hypertrophy. Aortic stenosis could be subvalvular, supravalvular or at the level of the aortic valve.
Pathophysiology
When the aortic valve becomes stenosed, it can result in the formation of a pressure gradient between the left ventricle (LV) and the aorta [1]. The more constricted the valve, the higher the gradient between the LV and the aorta. For instance, with a mild AS, the gradient may be 20 mmHg. This means that, at peak systole, while the LV may generate a pressure of 140 mmHg, the pressure that is transmitted to the aorta will only be 120 mmHg. So, while a blood pressure cuff may measure a normal systolic blood pressure, the actual pressure generated by the LV would be considerably higher.
In individuals with AS, the left ventricle (LV) has to generate an increased pressure in order to overcome the increased afterload caused by the stenotic aortic valve and eject blood out of the LV. The more severe the aortic stenosis, the higher the gradient is between the left ventricular systolic pressures and the aortic systolic pressures. Due to the increased pressures generated by the left ventricle, the myocardium (muscle) of the LV undergoes hypertrophy (increase in muscle mass). This is seen as thickening of the walls of the LV. The type of hypertrophy most commonly seen in AS is concentric hypertrophy, meaning that all the walls of the LV are (approximately) equally thickened.
In adults with AS, the obstruction develops gradually usually over decades. During this time, the left ventricle adapts to the systolic pressure overload through a hypertrophic process. However, if the hypertrophic process is inadequate and relative wall thickness does not increase in proportion to pressure, wall stress increases and the high afterload causes a decrease in ejection fraction [2]. Clinically, it is difficult to determine the cause of low ejection fraction whether it is due to depressed contractility or to excessive afterload. Corrective surgery will be more beneficial and will have better outcome when the low ejection fraction is caused by high afterload than when caused by depressed contractility of the myocardium.