What Is Aortic Calcification?

The aortic valve diseases that require surgical treatment are mainly the following 4 cases:

Aortic valve calcification is a congenital aortic valve disease that may be asymptomatic in early childhood. Common symptoms of aortic valve disease are palpitations, shortness of breath, and angina after exertion. In cases of severe aortic stenosis or aortic valve insufficiency, angina pectoris is particularly severe due to severe inadequate blood supply to the coronary arteries.

Aortic valve calcification etiology

The aortic valve diseases that require surgical treatment are mainly the following 4 cases:

Aortic valve calcification congenital aortic valve disease

The more common one is double leaflet malformation, and the clinical manifestations are mainly aortic valve stenosis. The transvalvular pressure difference during aortic valve systole often exceeds 13.3kPa (100mmHg). Electrocardiograms show high left ventricular voltage, often accompanied by strain. X-ray angiography and ultrasound often show that the left ventricular cavity is small and the myocardium is concentrically hypertrophic. Severe aortic stenosis can cause relative mitral regurgitation due to left ventricular systolic pressure.

Another common congenital aortic valve disease is aortic valve prolapse due to aortic valve leaflet prolapse. This malformation often occurs in cases of larger high ventricular septal defect or aortic valve sinus aneurysm breaking into the right ventricle. . In the larger cases of high ventricular deficiencies, the corresponding leaflets above them lose the support of the ventricular septum, and the ventricular diastolic valve leaflets prolapse through the ventricular defect to the right ventricle. In cases of ruptured Vascular sinus tumor, the corresponding aortic valve leaflet prolapses to the left ventricle.

Aortic valve calcification with aortic valve disease

About 20% of rheumatic mitral valve disease is associated with aortic valve disease. In rheumatic heart disease, simple arterial valve disease is rare. The three leaflets of the aortic valve have thickened fibrosis, contraction, sclerosis, and even calcification, and their mobility is very poor. Therefore, rheumatic aortic valve lesions are often double lesions with stenosis and insufficiency, and the disease course is longer. Cardiac impairment is also severe.

Aortic valve calcification aortic valve degenerative change

The aortic valve leaflets are mucus-like, the tissue is thin and translucent, and it cannot tolerate diastolic pressure in the aorta, resulting in insufficiency. Common in syphilitic aorticitis, Marfan syndrome, middle aortic necrosis, senile degenerative changes, and ascending aortic aneurysms caused by other causes. Due to severe insufficiency of the aortic valve, the pulse pressure of the peripheral arteries is significantly widened, and the left ventricle has a severe volumetric load increase in hemodynamics, so the left ventricle increases to the left, downward, and backward. Both ultrasound examination and left ventricular cavity showed significant enlargement of the left ventricular cavity and severe aortic regurgitation. The contrast medium flows back and forth in the left ventricle and the ascending aorta, and the residence time is longer, and it cannot be quickly emptied.

Aortic valve calcification bacterial endocarditis

Bacterial endocarditis that causes aortic valve disease often destroys the aortic valve leaflet tissue, creating vegetation, perforations, or tears on the leaflet. Therefore, aortic valve disease caused by bacterial endocarditis often manifests as aortic valve insufficiency. Due to the short course of disease and rapid changes in hemodynamics, it is difficult for the left ventricle to tolerate a sudden increased volumetric load. In addition, the vegetation may fall off and cause systemic arterial embolism.

Aortic valve calcification

Congenital aortic valve disease may be asymptomatic in early childhood. Common symptoms of aortic valve disease are palpitations, shortness of breath, and angina after exertion. In cases of severe aortic stenosis or aortic valve insufficiency, angina pectoris is particularly severe due to severe inadequate blood supply to the coronary arteries. Mild to moderate aortic stenosis or insufficiency may also be without symptoms. In cases of simple aortic valve stenosis, a rough systolic murmur can be heard in the aortic valve area, which is conducted to the neck. In the case of aortic valve double lesions or severe insufficiency, in addition to the typical murmurs heard in the aortic valve area, a louder round-trip hairy murmur can be heard in the second aortic valve area along the left side of the sternum. The systolic part is conducted to the neck through the second intercostal space along the right side of the sternum, while the diastolic part is conducted down to the apex of the heart along the left side of the sternum.

Aortic valve calcification related examination

Aortic valve calcification electrocardiogram

Shows enlarged left ventricle, often with strain or myocardial damage.

X Aortic valve calcification chest x-ray

It can be seen that the left ventricle is enlarged and the ascending aorta is widened to varying degrees. Severe aortic valve insufficiency increased most significantly in the left ventricle to the left, down, and backward. In the aortic stenosis, the left ventricle is concentrically hypertrophic. Retrograde aortic angiography can confirm the degree of incomplete closure. Contrast contrast agent in continuous radiography only showed a triangle in a small area under the aortic valve. The incomplete closure was mild; the contrast agent appeared as a long quadrangle to the apex. Severe incomplete closing during development. Selective left ventricular angiography can show the size and systolic function of the left ventricular cavity. In cases of aortic and stenosis, retrograde intubation often fails to enter the left ventricle. Continuous retrograde aortic radiography can also show that during ventricular systole, the aortic valve is rounded when it is opened, which is also a typical manifestation of aortic valve stenosis. Changes in left ventricular and ascending aortic pressure during left heart retrograde intubation were also significant. In cases of aortic valve stenosis, the left ventricular systolic pressure was significantly increased, and the systolic transvalvular pressure step exceeded 2.67 kPa (20 mmHg). During aortic valve insufficiency, aortic diastolic pressure decreases, pulse pressure exceeds 6.67 kPa (50 mmHg), and left ventricular diastolic pressure increases.

Aortic valve calcification ultrasound

Not only the size of the aortic valve opening, the degree of reflux, the diameter of the ascending aorta, and the diameter of the annulus can be measured, but also the diameter of the end-systole and end-diastole of the left ventricle can be measured to further understand the left ventricular ejection function. The development of color ultrasound in recent years has improved the accuracy of this non-invasive examination. Because ultrasound is safe, painless, and easily accepted by patients, it has replaced most of the left ventricle and retrograde aortic angiography.

Aortic valve calcification treatment

Congenital aortic valve malformations in early childhood, if there are no obvious clinical symptoms, children can grow up before surgery. In cases of congenital aortic valve prolapse, aortic valve suspension can be performed when repairing high ventricular septal defects or Watson's sinus tumor. In adults, mild to moderate aortic stenosis or insufficiency can be postponed until clinical symptoms appear. However, if patients with severe mitral valve disease need to be treated with mitral valve surgery, the aortic valve disease should be treated in the same period. Otherwise, after the correction of mitral valve disease, the left ventricle will discharge more blood into the aorta, and the hemodynamic changes caused by the aortic valve disease will be aggravated, which will overload the left ventricle, and the left heart will appear after surgery. Exhaustion. Therefore, in patients with rheumatic heart disease, patients with mitral valve and aortic valve double valve double disease, the surgical treatment plan should be considered in combination with the situation of the two valve disease.

In cases of aortic stenosis and insufficiency, the most dangerous symptoms are angina and syncope. These two symptoms are the manifestations of myocardial ischemia and cerebral ischemia. Patients can have cardiac arrest or ventricular fibrillation at any time and fall to the ground. Therefore, patients with a history of angina pectoris or (and) syncope should have surgery early.

The pressure on the aortic valve is high. Even simple aortic valve stenosis, after the valve junction incision, often causes obvious insufficiency. At the same time, due to severe aortic valve stenosis, valve leaflet thickening and calcified lesions often occur. Incision or dissection is difficult to receive satisfactory results. Therefore, aortic valve disease often requires valve replacement surgery, which removes the diseased aortic valve and replaces it with an artificial valve. The prosthetic valve placed at the position of the aortic valve is subject to left ventricular ejection, and the thromboembolism rate is lower than that of mitral valve replacement. However, if mechanical valve is used for aortic valve replacement, lifelong anticoagulation treatment is still required. Those using bioprosthetics also need anticoagulation for at least 3 months. Regardless of the mechanical or biological valve, the valve with larger opening area and lower resistance should be selected.

Aortic valve calcification

Aortic valve calcification aortic valve suspension

Prolapsed aortic valve leaflets are usually the right coronary valve leaflet or non-coronary leaflet above the defect. After the extracorporeal circulation is established, an oblique transverse incision in the anterior wall of the ascending aorta is used. The aortic valve was well exposed (Figure 1). The normal valve sinus was deep, and the edges of the valve leaflets and junctions were normal, while the prolapsed valve leaflets were elongated, the valve sinuses became shallow, and prolapsed toward the ventricle. At the junction, the prolapsed valve becomes thinner along the edges

When suspending, hold one end of the prolapsed leaflet with non-invasive tweezers and tighten it to the junction to estimate the degree of prolapse and the extent of suture overlap. Then use double heads with polyester or tetrafluoroethylene gaskets without damage. Thread the needle through the overlapping valve rim and leaflet, pierce through another spacer outside the ascending aortic wall, and ligate. The main points of suspension are: The gasket must be placed vertically so that the entire gasket presses on the leaflets to prevent the leaflets from tearing; The prolapsed leaflets must be about 1mm higher than the normal leaflets at the junction. Deepen the valve sinus and the valve is well aligned; The edge of the prolapsed valve must be slightly tightened when suspended, and a little overcorrection can make the valve better withstand the aortic diastolic pressure. This method of suspension is more accurate and effective than the method of judging the degree of prolapse and the range of suspension by using a filament to pull the Morgagni nodules in the center of the three leaflets. Thinning and loosening, suspension should be performed with gaskets at both ends of the leaflets.

Aortic valve calcification aortic valve replacement

When the aortic valve is severely damaged and cannot be repaired, an aortic valve replacement is required, and a disc mechanical valve or a biological valve can be selected. In cases of degenerative lesions or large annulus, the annulus is often soft and brittle. After resecting the diseased valve, a 2-0 double-ended needle with polyester or tetrafluoroethylene gasket is used without injury. Place the needle and spacer on the aortic side.

In rheumatic lesions, the annulus tissue is often thickened and very hard, with the annulus shrinking. In order to place a larger-diameter artificial valve, the artificial valve is preferably placed above the annulus. In this case, a double-headed, non-invasive needle and thread without a gasket can be used. The needle is inserted from the ventricular side to the aortic side, and the needle loop is inserted from the bottom to the top. After the suture is ligated, the prosthetic valve is placed over the annulus (Figure 3).

After the biological valve replaces the aortic valve, anticoagulation therapy is applied for 3 to 6 months. After mechanical valve replacement, lifelong anticoagulation therapy is required, and the prothrombin time is maintained at 50% of normal.