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Radiology
Aortic Stenosis and Aortic Atresia
Built from Obstetric Imaging
What’s inside
8 sections · 53 slides
Overview
- What you will learn here
The blocked exit of the left heart
What the defect is, where it sits, and how often it occurs
- The left side of the heart has only one way out
- Where exactly the narrowing sits
- Three levels of left outflow obstruction
- 1 in 7000
- Why those numbers matter
Causes and the company it keeps
Inheritance, syndromes, valve anatomy and associated defects
- What causes it
- Each level keeps different company
- When both left heart doors are shut
- What the faulty valve looks like
- Other heart defects travel with it
What the blockage does to the heart
From a small rise in pressure to a hypoplastic left ventricle
- The chain of damage
- Mild narrowing: the heart still copes
- As the blockage tightens
- When the strain goes on too long
- Globular left ventricle with bright walls
- The worst end of the spectrum
How the baby presents
The same defect can be silent for decades or fatal in a week
- Two very different clinical stories
What to look for on the scan
Colour Doppler, the four-chamber view, the valve and the arch
- Colour Doppler is the key to the mild cases
- Aliasing at the aortic valve in mild aortic stenosis
- Pulsed Doppler tracing across the narrowed valve
- What the four-chamber view shows
- The inlet valve starts to leak as well
- Mitral regurgitation reaching the roof of the left atrium
- The valve itself on grey-scale imaging
- Thickened, bright aortic valve during systole
- Measuring the jet through the valve
- Turbulent flow through the valve in critical disease
- Accelerated flow through the valve in moderate disease
- Which way the arch flows tells you the severity
- Reversed flow in the aortic isthmus
- Classic signs
- A ladder of severity
- One critical case, view by view
What can be done before birth
Work-up, counselling, surveillance and fetal valvuloplasty
- The first steps once AS is found
- What the parents need to be told
- Opening the valve before birth
- Valvuloplasty needle below the thickened aortic valve
- Choosing who should be treated
- Fetal Aortic Valvuloplasty Selection Criteria
- How to read that table
Treatment after delivery
Balloon, prostaglandins, or a three-stage single-ventricle route
- Relieving the obstruction after birth
- When the left heart cannot be used at all
- The three-stage single-ventricle route
- What the referring doctor needs to know
- Critical stenosis progressing to a hypoplastic left ventricle
- Small hypertrophic left ventricle on grey-scale
- Reduced mitral filling on colour Doppler
- Key points
- Suggested readings
- References
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition