Aortic Stenosis

Causes of aortic stenosis

Aortic stenosis is the most common form of valvular heart disease, occurring more often in men than women. For most people, the condition develops with age. More than 2.5 million people over the age of 75 in the United States have aortic stenosis.

Severe aortic stenosis may be related to a number of factors:

• Aging. Age-related aortic stenosis usually begins after age 60 as a result of calcium buildup in the valve. Symptoms often don't appear until a person is 70 or even 80.
• Radiation therapy. This treatment used for certain cancers can cause thickening and calcification of the valve.
• Bacterial infection. Rheumatic fever and similar infections can cause the formation of scar tissue in the heart that can prevent the valve from working normally.
• High cholesterol. This condition increases fat deposits, which can narrow the valve opening.
• Birth defect. Some people are born with an abnormality that affects the valve's structure and how well it functions.

Symptoms of aortic stenosis

Signs of aortic stenosis can depend on the stage of the condition, which ranges from mild to severe.

Mild to moderate aortic stenosis

In the mild to moderate stated of aortic stenosis, blood flow isn't restricted enough to cause significant symptoms Many people don't know they have the condition at this stage. Or they have minor symptoms, like tiredness or swollen ankles, which could be easily misinterpreted as common signs of aging. Some may be told during a routine checkup that they have a heart murmur.

Severe aortic stenosis

As the condition progresses, the valve opening narrows further and the heart muscle weakens. Patients notice uncomfortable symptoms, such as shortness of breath or fatigue. This can be life-threatening, so it's crucial to tell your doctor right away if you notice new symptoms or your symptoms worsen.

Diagnosis of aortic stenosis

We use several tests to diagnose aortic stenosis and assess its severity. These tests include:

• Transesophageal echocardiogram (TEE). A TEE is an ultrasound test that produces images of the heart chambers, valves and blood flow, and can also show if blood is clotting inside the heart. A long flexible tube conveys a device that emits sound waves down the throat. This provides clearer images than those obtained from outside the body.
• Aortic angiogram. During this imaging test, the doctor inserts a thin, flexible tube called a catheter into a blood vessel (usually in the groin area) and threads it up to the heart. The doctor then injects a harmless dye through the catheter that allows them to see the flow of blood to the heart.
• Chest X-ray. This imaging test reveals the presence of calcium deposits and shows the size and shape of the heart and lungs. All patients who need heart valve surgery have a chest X-ray beforehand.

Treatment of aortic stenosis

To monitor your condition, the American College of Cardiology and American Heart Association recommend having an echocardiogram every three to five years if you have mild aortic stenosis and every one to two years if you have moderate aortic stenosis.

Your treatment depends on the severity of your condition. If the stenosis is mild or moderate, you may not need treatment. As the disease progresses, you may need to have the damaged valve replaced. There are several ways to do this, including:

Open-heart surgery

In open-heart surgery, the surgeon makes an incision in the middle of the chest to remove and replace the damaged valve. The new valve may be made from animal tissue or a durable material, such as titanium. Or, in an open-heart operation known as the Ross procedure, another of the patient's own functional heart valves is used as the replacement.

Because the heart's beating must be paused for these procedures, the patient is placed on a heart-lung bypass machine during the operation.

Some patients aren't candidates for open-heart surgery because they are too ill or have other conditions that make it too risky. The Ross procedure is generally only for patients under the age of 60.

Minimally invasive valve replacement

As with open-heart surgery, the patient must be on a heart-lung bypass machine during a minimally invasive valve replacement. However, the surgeon performs the procedure via a much smaller incision in the chest, using a tiny camera and slender tools to remove and replace the damaged valve. This is an option for some patients who can't have traditional open-heart surgery.

Transcatheter aortic valve replacement (TAVR)

Transcatheter aortic valve replacement (TAVR) is an even less invasive procedure we can offer to some patients, based on their evaluation. Instead of making an incision in the chest, the surgeon threads a catheter through a blood vessel to reach the heart, then inserts a new valve inside the old one. TAVR is performed while the heart is beating, so the patient doesn't need to be on a heart-lung bypass machine.

Balloon aortic valvuloplasty

This minimally invasive procedure aims to widen the narrowed valve rather than replace it. A catheter with a tiny, deflated balloon at its tip is threaded through a blood vessel until it reaches the damaged valve. At that point, the balloon is inflated to expand the narrowed valve. The balloon is then deflated, and the catheter is withdrawn.