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Aortic Stenosis

What is aortic stenosis?

The heart is made up of four distinct chambers - two upper chambers called the atria, and two lower chambers are called the ventricles. Blood flows between these chambers with every pump of the heart. Between the left ventricle and the aorta is a valve that opens and closes to allow blood to flow. The valve has thin tissue or leaflets that act as the gate. When it’s closed, blood doesn’t get through.

Aortic stenosis, or aortic valve stenosis, is a condition where those leaflets in the aortic valve become thickened, calcified and stiff. This causes narrowing of the opening of the aortic valve.

What causes aortic stenosis?

Being born with congenital heart conditions may increase your risk for aortic stenosis, but for the majority of affected people, aortic stenosis develops without any congenital predisposition. There are four common causes for aortic stenosis.

  • Calcium build-up due to wear and tear (the most common cause)
  • Congenital heart defects, such as congenital bicuspid valve disease
  • Prior rheumatic fever
  • Prior radiation therapy

How does the valve wear out?

For a typical 60-year-old individual, the aortic valve has opened and closed 1.8 billion times. This wear and tear results in the most common form of aortic stenosis. The repeated opening and closing of the valve results in calcium build-up which ultimately restricts the valve from opening completely. Even though aortic valves can degenerate, or deteriorate, it is quite impressive how long they can do their job - imagine if mechanical components in your car were subjected to this level of continuous repetitive stress.

Who is at the greatest risk for aortic stenosis?

Aortic stenosis is more commonly found in men. Age is a key factor for those with severe aortic stenosis. For most, the calcium build-up around the valve happens over years. While not all risk factors are under your control, healthy choices could help to lower your risk significantly. 

Some of the common risk factors include:

  • Age - your risk increases as you get older
  • History of rheumatic fever
  • High cholesterol
  • Smoking
  • Kidney disease
  • Hypercalcemia (elevated calcium levels in the bloodstream)
  • Diabetes
  • Metabolic syndrome
  • Being male

What are the symptoms of aortic stenosis?

It’s important to take symptoms of aortic stenosis seriously. They may be mistaken for other heart conditions, so diagnosis is key to fast and effective treatment. If you experience any of the following symptoms, make an appointment with your primary care physician or cardiologist.

  • Shortness of breath
  • Not being able to exercise as one used to
  • Chest pain (angina)
  • Dizziness and fainting when exerting yourself
  • Heart palpitations

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

The importance of getting treatment

For those experiencing symptoms of aortic stenosis, damage to the aortic valve may already be severe. With this damage, lifestyle changes alone may not be enough to prevent life-threatening outcomes like heart attack. And left untreated, patients with severe aortic stenosis may have a shortened life expectancy of only 2-5 years.

Treatments for aortic stenosis

Since aortic stenosis is a mechanical problem in the heart, it requires a mechanical fix or solution. For those with severe aortic stenosis symptoms, the only lasting treatment will require surgery. Your cardiologist may suggest a combination of medication and surgery to treat the symptoms while delivering a long-term solution.

Non-surgical treatment

Medication can be effective in lessening your symptoms while a definitive treatment is determined. Some of the medicines that your doctor may prescribe include diuretics to manage fluid overload and beta blockers to help control your blood pressure

Ultimately, patients suffering from severe, symptomatic aortic stenosis will need replacement of their aortic valve, which can either be accomplished via open heart surgery or via a minimally invasive procedure.

Surgical aortic valve replacement (SAVR; open heart surgery)

Before 2011, patients would likely have open-heart surgery to replace the damaged valve and improve blood flow. Surgical aortic valve replacement (SAVR) involves open-heart surgery. The surgeon cuts open your chest to get access to the heart to repair or replace the valve while you are asleep under general anesthesia. It can take anywhere from two to three months for you to recover.

Transcatheter aortic valve replacement (TAVR; minimally invasive)

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

This treatment involves making a small incision that’s less than one centimeter—usually in your upper thigh—into the femoral artery. The physician then inserts a long, flexible tube that is the diameter of a pencil into the artery. The aortic valve is repaired or replaced with the same result as open-heart surgery, but with significantly less trauma to the patient, leading to a faster recovery.

This entire process takes about an hour, and two doctors do it while your heart is beating and, in most cases, without the need for general anesthesia.

TAVR is becoming a more common practice, but it may not be right for all patients. For example, 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 these cases are rare. A cardiologist will be able to make a recommendation based on the information gathered during diagnosis.

Life after aortic stenosis treatment

SAVR and TAVR procedures greatly improve the longevity and quality of life for patients with aortic stenosis. Prior to treatment, patients may struggle to exercise or even do simple tasks. The risk for heart failure can become severe as the valve becomes narrower and the risk alone may hold you back from the things you love. 

Most patients who have undergone treatment for aortic stenosis will continue to receive lifelong follow-up to ensure that the valve continues to work as it should. But otherwise, the replaced valve will allow you to return to regular activities and exercise. Heart valve repair is a life-changing and lifesaving treatment. 

Lowering your risk for aortic stenosis

To reduce your risk for aortic stenosis later in life, it’s important to manage and treat any of the underlying risk factors you may have. To reduce your risk for aortic stenosis later in life, it’s important to manage and treat any of the underlying risk factors you may have. Practice heart healthy habits such as:

Act now

If you are experiencing any of the symptoms of aortic stenosis or if you have any concerns, contact your health care provider. 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. Schedule an appointment with a Banner Health cardiologist to get a full diagnosis and begin treatment.

You can learn more about your heart health by taking our Heart Age Test