Aortic stenosis, perioperative hemodynamic goals


Important essentials Anesthesiologist should know about Aortic Stenosis:

  • Normal aortic valve  orifice is 2.5 - 3.5 cm²
  • Critical aortic stenosis is 0.5–0.7 cm²
  • A decreased valvular area causes increased pressure gradient ( mmHg): 
    • Mild  <  25
    • Moderate 25 - 40
    • Severe  >  40
    • Very severe  >  70
  • Triad of Symptoms: 
    • Dyspnea on exertion
    • Angina
    • Orthostatic or exertional syncope
      • Diastolic dysfunction is the result of an increase inventricular muscle mass, fibrosis, or myocardial ischemia.

      • Loss of atrial systole can precipitate congestive heart failure or hypotension in patients with aortic stenosis.

      • Patients may experience angina even in the absence of Coronary Artery Deasease.

      • Once symptoms develop, most patients, without surgical treatment, will die within 2–5 years.

       ANESTHETIC MANAGEMENT

       click to enlarge:
      aortic stenosis goals



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