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

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