What is Aortic Valve Stenosis and its symptoms?

The aortic valve is located between the left chamber of the heart and the aorta which is a principal artery delivering blood from the heart to the body. Aortic valve stenosis (AS) occurs when this valve gets narrowed or doesn’t open properly. If this occurs, the heart needs to work more against this narrowed valve to pump required quantity of blood into the aorta. This situation can lead to thickening and enlargement of the heart eventually leading to heart failure.

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

Patients with severe Aortic valve stenosis may experience the following symptoms:

  • Pain or Tightness in Chest with Activity (Angina)

  • Feeling of Dizziness or Fainting during Activity

  • Tiredness (Fatigue)

  • Shortness of Breath (Dyspnoea)

  • Irregular heartbeats (Arrhythmia) or Heart Palpitations

  • Swelling in your Legs

Up to 50% of patients with severe aortic valve stenosis may die within an average of two years if not treated with aortic valve replacement.

Causes of Aortic Valve Stenosis:

  • Age

  • Calcium Build-up

  • Genetic Predisposition

  • Rheumatic Heart Disease

  • Radiation Exposure

Degenerative Aortic valve disease affects over 25% of all patients over the age of 65 years

How to Diagnose Aortic Valve 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.

Treatment Options for Aortic Valve Stenosis:

Medications: If you are having no or mild symptoms, your doctor may prescribe you medications along with periodic check-up. The medicines will make you feel better in the short term, but ultimately you will require intervention.

Balloon Valvuloplasty (BAV): A long, thin tube (catheter) with a little balloon on its tip is inserted by the doctor into an artery. This balloon is guided till the aortic valve is reached and then inflated to expand the valve opening. Then, the balloon is deflated, and the catheter and balloon are finally removed. However, this approach can only provide temporary relief. Normally, this method is performed in patients who are severely ill for surgery or are awaiting valve replacement.

If the Aortic valve Stenosis is severe your doctor may advise either open heart surgery (SAVR) or Transcatheter Aortic Valve Replacement (TAVR).

Surgical Aortic Valve Replacement (SAVR)/Open Heart Surgery:

Most open heart surgeries are performed through sternotomy. It means the patient is placed under general anaesthesia 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 insert a new valve. The heart is then restarted and the chest incision is closed.

There are two different types of surgical valves:

  • Mechanical (man-made material)

  • Biological (animal or human tissue

Biological valves get degraded over time and may require another replacement. On the other hand, mechanical valves will require lifelong blood thinning medicines. Hence, discuss with your doctor to determine which valve may be best suited for you.

Patients usually need to stay in the hospital for a week or more, before beginning a long period of recovery. SAVR can also be a challenge in elderly with multiple co-morbidities as it may increase the risk of death in such patients.

Transcatheter Aortic Valve Replacement (TAVR):

TAVR procedure can be done without general anesthesia and does not require stopping the heart or opening the chest cavity. It is a minimally invasive, 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 undertaken in the Cardiac Catheterization Lab (Cath-lab).

If you have been diagnosed with severe aortic stenosis and your doctor has evaluated you to be at a high risk for surgery, TAVR may be a better alternative for you. However only a specialized Heart Team can determine which treatment option is best for you.