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Aortic Stenosis
Aortic Stenosis

What is Aortic Stenosis ?
Aortic valve stenosis (AS) develops when aortic valve gets narrowed or is unable to open properly. If this happens, for pumping the required quantity of blood into aorta, the heart needs to work more against this narrowed valve. This situation can lead to thickening and enlargement of the heart eventually leading to heart failure.

The severity of the Aortic valve stenosis ranges from mild to severe. Many patients might not experience any symptoms of Aortic valve stenosis until the disease reaches a high severity.

What are the common Symptoms?

Signs and symptoms generally start appearing when the narrowing of the valve is severe.The most common symptoms may include:

  • Abnormal heart sound (heart murmur)
  • Chest pain (angina) or tightness with activity
  • Feeling of dizziness or fainting during activity
  • Shortness of breath, on exertion
  • Fatigue, especially during times of increased activity
  • Rapid, fluttering heartbeat (palpitations)
  • Not eating enough (mainly in children with aortic valve stenosis)
  • Not gaining enough weight (mainly in children with aortic valve stenosis)

Cause of Aortic Stenosis
Aortic Stenosis can be caused by one of the following reasons:

Congenital Heart Defect
Some children are born with an aortic valve that has only two cusps instead of three. This valve defect may not cause any problems until adulthood.

Advancing Age
Aortic stenosis mainly affects older people as a result of scarring and calcium buildup in the valve cusp (flap or fold).

Calcium Build-up
Calcium deposits can build up on the heart valves (aortic valve calcification) which result in stiffening of the valve cusps.

Genetic Predisposition
Genetic predisposition comes from genetic variations that are passed down from parent to child.

Rheumatic Heart Disease
This complication of strep throat infection may result in scar tissue forming on the aortic valve. Scar tissue narrows the aortic valve opening or creates a rough surface which enables calcium deposition.

Radiation Exposure
Exposure to heavily radio-active substance may cause chances of Aortic Stenosis.

How to Early Diagnose the Aortic Stenosis
A disorder of the heart valve usually leads to an abnormal heart sound (murmur). In case your doctor hears such a murmur during physical examination, he/she will recommend tests such as ECG, Echocardiography and a six-minute walk test. To confirm further, a CT scan and few other blood tests will be done.
Once confirmed the further management of Aortic valve stenosis will depend on its severity and associated symptoms.

Electrocardiogram (ECG or EKG)
This painless test detects and records your heart's electrical activity using small sensors (electrodes) attached to your chest and arms and, sometimes, legs. AnEKGcan detect enlarged chambers of your heart, heart disease and abnormal heart rhythms.

Chest X-Ray
It will help to determine whether your heart is enlarged, which can occur in aortic valve stenosis. It can also show calcium buildup on your aortic valve swelling of the aorta.

Exercise Tests or Stress Tests
It helps to determine whether signs and symptoms of aortic valve disease occur during physical activity and can help to determine the severity of your condition. If you are unable to exercise, medications that have similar effects as exercise on your heart may be given to complete the test.

Cardiac Computerized Tomography (CT) Scan
A cardiacCTscan combines several X-ray images to provide a more detailed cross-sectional view of the heart. Doctors may use cardiacCTto measure the size of your aorta and look at your aortic valve more closely.

Cardiac MRI
A cardiacMRIuses magnetic fields and radio waves to create detailed images of your heart. This test may be used to determine the severity of your condition and evaluate the size of your aorta.

Cardiac Catheterization
This test isn't often used but it may be used if other tests aren't able to diagnose the condition or to determine its severity. It may also be used before aortic valve surgery to make sure the arteries that feed the heart muscle (coronary arteries) are not blocked.

Don't Worry it is Curable!

Treatments of Aortic Stenosis
Modern Science has made it possible to treat the most complex structural heart issues, including Aortic Stenosis.
Treatment for aortic valve stenosis depends on your signs and symptoms and the severity of the condition.

Here is a list of treatments:

1 Medications
If you are having no or mild symptoms, your doctor may prescribe you some medications along with periodic check-up. The medications will act for short term and will make you feel better, but ultimately you will require further evaluation and possible intervention.
Aortic valve repair.To repair an aortic valve, surgeons separate valve flaps (cusps) that have fused. However, aortic valve repair is rarely considered a primary treatment to treat aortic valve stenosis

2 Balloon Valvuloplasty (BAV)
This method is performed in patients severely ill for surgery or awaiting a valve replacement. A long, thin tube (catheter) with a little balloon on its tip is inserted into an artery. Valve opening is expanded by guiding and inflating this balloon to the aortic valve. The balloon is then deflated, and the catheter and balloon are finally removed. However, this approach only provides temporary relief.
If the Aortic valve stenosis is severe, your doctor may advise either open heart surgery (SAVR) or Transcatheter Aortic Valve Replacement (TAVR)

3 Surgical Aortic Valve Replacement (SAVR)/Open Heart Surgery
Aortic valve replacement is often needed to treat aortic valve stenosis. In this, your surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).
Most open-heart surgeries are performed through sternotomy. The patient is placed under general anesthesia and the breast bone is cut open. The heart is stopped and a heart lung machine takes over the function of the heart temporarily. The surgeon will then completely remove the diseased aortic valve and place a new valve. The heart is then restarted and the chest incision is closed.
Biological tissue valves break down over time and may eventually need to be replaced. People with mechanical valves will need to take blood-thinning medications for life to prevent blood clots. Your doctor will discuss with you the benefits and risks of each type of valve.

4 TAVR System
Transcatheter Aortic Valve Replacement (TAVR)
TAVR procedure is minimally invasive, can be done without general anesthesia and does not require stopping the heart or opening the chest cavity. It is a catheter-based technique during which the doctor replaces the patient’s diseased valve with a bioprosthetic valve. Once in place, the valve immediately begins functioning. You will be discharged from the hospital within a few days and will have a much shorter recovery period compared to open heart surgery. This novel, interventional technique is somewhat similar to angioplasty and is done in the Cardiac Catheterization Lab (Cath-lab)

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