STENOSIS AORTA

(SA)

Sabrina Andiani K.
121.0211.199
A1
 Normal AV
The aortic valve controls the direction of blood flow from
the left ventricle to the aorta
The aortic valve has three flaps, called "cusps," or
leaflets that open and close
During ventricular systole, pressure rises in the left
ventricle. When the pressure in the left ventricle rises
above the pressure in the aorta, the aortic valve opens,
allowing blood to exit the left ventricle into the aorta
When ventricular systole ends, pressure in the left
ventricle rapidly drops. When the pressure in the left
ventricle decreases, the aortic pressure forces the aortic
valve to close
 Malfunctions
If the valve does not open
fully, it will obstruct the flow of
blood. This is called valve
stenosis
If the valve does not close
properly, it will allow blood to
leak backwards. This is called
valve incompetence or
regurgitation
Heart valves can have both
malfunctions at the same time
(regurgitation and stenosis).
Also, more than one heart valve
can be affected at the same
time
 Definisi:
PJB yg disebabkan o/ kelainan perkembangan
struktural dr lembaran2 katup
Epidemiologi:
5 dr 10.000 kelahiran hidup
: = 4:1
20% pasien memiliki kelainan tambahan
(biasanya berupa koarktasi aorta)
 Etiologi:
1. Malformasi katup stenosis kongenital
(usia < 15 thn)
2. Malformasi katup bikuspid kongenital
stenotik akibat kalsifikasi (hingga usia 65 thn)
3. Stenosis inflamasi rematik pd katup
trikuspid
 Calcific Aortic Stenosis
Nodular calcific masses on aortic side of cusps
No commissural fusion
Free edges of cusps are not involved
Stellate-shaped systolic orifice
 Bicuspid Aortic valve
Fusion of the right and left coronary cusps
(80%)
Fusion of the right and non-coronary
cusps(20%)
 Rheumatic aortic stenosis
Characterized by:
Commissural fusion
Triangular systolic orifice
Thickening & calcification
Accompanied by rheumatic mitral valve
changes
 Types:
Valvular Most common
Subvalvular(subaortic) involves the left
outflow tract
Supravalvular involves the ascending
aorta is the least common
 Supravalvular/Subvalvular

Occasionally the obstruction does not

involve the Aortic valve B itself but
consists of a narrowing of the passage
either above Supravalvular or below
Subvalvular it.
Supravalvular: The narrowing is in the
Aorta itself immediately above the valve
A
Subvalvular: The narrowing occurs
within the Left Ventricular Outflow tract
below the Aortic valve C
 Patofisiologi:
 Gejala:
Manifestasi klinis:
Takikardi
Takipnea
Gagal tumbuh
Susah makan
Pd anak2 yg lebih besar biasanya asimtomatik &
berkembang secara normal. Tapi jika gejala muncul
akan seperti gejala pd org dewasa, a.l:
Fatigue
Dispnea
Angina pectoris
Sinkop
 Px. Fisik:
Auskultasi: terdengar bising sistolik murmur
kresendo-dekresendo yg keras (paling keras di
jantung bagian bawah dgn penjalaran sampai ke
leher)
Diagnosis:
Radiografi dada:
Pembesaran LV
Dilatasi aorta ascendens
EKG:
Hipertrofi LV
 LV Hypertrophy
The left ventricle initially
compensates for increased
resistance caused by aortic stenosis
by thickening to help eject blood
through the stenotic aortic valve
into the aorta. The myocardium
(muscle) of the LV undergoes
hypertrophy (increase in muscle
mass). The type of hypertrophy
most commonly seen in AS is
concentric hypertrophy, meaning
that all the walls of the LV are
(approximately) equally thickened.
 Ekokardiografi, u/ menilai:
Struktur abnormal pd katup aorta
Mobilitas daun katup
Ketebalan katup
Penyatuan subvalvular
Derajat hipertrofi LV
Penilaian Doppler, u/ mengukur:
Gradien tekanan lintasan stenotik katup
Area katup
Kateterisasi jantung:
u/ menegaskan gradien tekanan katup stenotik
 Tatalaksana:
AS tidak perlu dikoreksi, tapi harus dipantau
derajat dr stenosis yg bisa memburuk sewaktu-
waktu
Trancatheter balloon valvuloplasty, merupakan
intervensi I, tapi operasi mungkin diperlukan
jika valvuloplasty gagal membebaskan
obstruksi / jika terdapat regurgitasi aorta yg
signifikan akibat dilatasi balloon
Valvuloplasty pd masa kanak hanya sbg
tindakan paliative & pengulangan dilatasi
catheter balloon/revisi operasi mendatang
Referensi:
1. Pathophysiology of Heart Disease (Leonardo
S. Lilly)
2. Patofisiologi Sylvia, vol. 1, edisi 6
3. Teks & Atlas Berwarna Patofisiologi Silbernagl
4. Patologi Robbins-Kumar, vol. 2, edisi 7