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How Serious Is Aortic Stenosis And Do You Need To Worry?

You know how important your heart is and the importance of doing what you can to take care of your heart to keep it happily beating well into your old age. However, life has a way of catching up with you, and you may be finding that you are more tired and out of breath than usual because your heart isn’t pumping blood as well as it should be. When this happens, you could have a condition called aortic stenosis or aortic valve stenosis.

Aortic stenosis may not have the name recognition of heart attacks or get the same attention as atrial fibrillation, also called AFib. However, experts estimate that more than 1.5 million people in the United States have aortic stenosis, and as the population ages, that number will likely start increasing.

Jason Hatch, MD, is an interventional cardiologist at Banner Health in Northern Colorado and an expert in structural heart diseases and their treatments. Because of his expertise in the field, Dr. Hatch offered to explain what aortic stenosis is and what treatment options are available.

What is aortic stenosis?

If you read our post about AFib, you might remember the description of the heart and how it works. If not, here’s a reminder: The heart is made up of four distinct chambers. You have two upper chambers called the atria, and two lower chambers are called the ventricles. One of the lower chambers, the left ventricle, acts as the main pumping chamber, and it pumps into an artery called the aorta.

Between the left ventricle and the aorta is a valve that will open and close to allow blood to flow as the heart pumps. The valve has thin tissue or leaflets that act as the gate. When it’s closed, blood doesn’t get through, but when opened, the ventricle can push the blood through.

Dr. Hatch explains that aortic stenosis is a condition where those leaflets in the aortic valve become thickened, calcified and stiff. This causes the valve to not open and/or close as it should, creating a narrowing of the opening of the aortic valve.

“As the opening becomes smaller, the heart has to work harder to pump blood, which can lead to symptoms such as shortness of breath, chest pain and dizziness,” Dr. Hatch said.

Who gets aortic stenosis?

Aortic stenosis is a very common heart valve disorder that, as Dr. Hatch notes, tends to develop as people get older. Also, it affects men more than women.

Dr. Hatch explains it is typically caused in 1 of 4 ways:

  • Calcium build-up, which is the most common
  • Congenital heart defects, such as congenital bicuspid valve disease
  • Prior rheumatic fever
  • Prior radiation therapy

Some of the common risk factors include:

  • Age
  • History of rheumatic fever
  • High cholesterol
  • Smoking
  • Kidney disease
  • Hypercalcemia (elevated calcium levels in the bloodstream)
  • Diabetes
  • Metabolic syndrome
  • Being male

Symptoms of aortic stenosis are very telling, although they may take a while to present themselves. These include:

  • Shortness of breath
  • Not being able to exercise as one used to
  • Chest pain, dizziness and fainting when exerting yourself

After symptoms appear, your doctor will conduct a thorough physical exam to determine what further course of action is necessary. This may include an echocardiogram (EKG), which is an ultrasound of your heart. 

Aortic stenosis treatment

If you are diagnosed with severe, symptomatic aortic stenosis, meaning that the valve narrowing is significant and that symptoms are present, your cardiologist will recommend treatment. And, treatment is absolutely necessary. 

“Aortic stenosis is a deadly disease,” Dr. Hatch said. “Once patients with severe aortic stenosis develop symptoms related to their valve disease, these patients have a survival rate as low as 50% at 2 years and 20% at 5 years without aortic valve replacement.”

While medicine can help with the symptoms, it cannot reverse or treat the disease. Some of the medicines that your doctor may prescribe include diuretics to manage fluid overload and beta blockers to help control your blood pressure. Your doctor may also recommend medication to control your cholesterol and help slow the progression of aortic stenosis.

“Aortic stenosis represents a mechanical problem that needs a mechanical fix,” Dr. Hatch said. “Ultimately, patients suffering from severe, symptomatic aortic stenosis require replacement of their aortic valve, which can either be accomplished via open heart surgery or via a catheter-based procedure.”

Before 2011, patients would likely have open-heart surgery to replace the damaged valve. Surgical aortic valve replacement, shortened to SAVR, is likely what you imagine when thinking about open-heart surgery. The surgeon cuts open your chest to get access to the heart to put the new valve in place while you are under general anesthesia. It can take anywhere from 2 to 3 months for you to start feeling like yourself.

About TAVR

After 2011, the U.S. Food and Drug Administration (FDA) approved a minimally-invasive procedure called transcatheter aortic valve replacement, or TAVR. Typically, you start feeling like yourself 1 to 4 weeks after the procedure—much quicker than with open heart surgery.

This treatment involves making a small incision that’s less than 1 centimeter—usually in your upper thigh—into the femoral artery. The surgeon then inserts a long, flexible tube that is the diameter of a pencil into the artery.

Through the tube, a balloon is guided through the artery to where the old valve is. The balloon is inflated to push aside the existing damaged valve, and then deflated and removed from the artery.

The new aortic valve in a compressed form is mounted onto a balloon that is on a long tube or delivery catheter. The delivery catheter is advanced through the catheter into the femoral artery over a wire and is positioned across the old diseased aortic valve. Once in place, the surgeon inflates the balloon, and the new valve expands and is held in place by the diseased valve. This entire process takes less than 2 hours, and surgeons do it while your heart is beating and, in most cases, without the need for general anesthesia.

According to Dr. Hatch, most TAVR cases will also use a second device called the Sentinel. The Sentinel device consists of 2 small, cone-shaped filters, which are temporarily placed in the arteries supplying the brain to catch any calcified debris that may break loose when replacing the damaged valve. Surgeons use the Sentinel device to help lower the chance of stroke during the TAVR procedure. Once the new valve is in place, the surgeon removes the Sentinel device.

As good as TAVR is, it may not be for everyone. Dr. Hatch notes it is currently only approved for patients with severe, symptomatic aortic stenosis who are at least at intermediate risk or higher for SAVR. He believes it will eventually be approved for low-risk SAVR patients as well. TAVR is also approved in patients who have failing or failed surgical tissue valves (significantly narrowed or leaky) that need to be replaced.

TAVR is not approved for patients who have been diagnosed with aortic insufficiency—a leaky aortic valve. Plus, certain anatomic features may prevent a patient from being able to have the TAVR procedure, but Dr. Hatch notes that these cases are rare.

What you can do now

To reduce your risk for aortic stenosis later in life, you should manage and treat any of the underlying risk factors you may have. For example, you can quit smoking or change to a lower-cholesterol diet.

Also, remember, because aortic stenosis exists on a spectrum, you may not know you have it until it is severe. If you’ve been diagnosed, it’s time to act.

“If patients have a diagnosis of aortic stenosis, I encourage them to seek consultation with a cardiologist or expert in the management and treatment of aortic valve disease,” Dr. Hatch said.

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