Aortic Stenosis

  • Posted on: Jun 24 2020
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What is Aortic Stenosis?

Aortic stenosis occurs when the aortic valve leaflet thickened causing narrowing of the aortic valve opening. The narrowing of the aortic valve decrease blood flow from the heart to the body and the heart must work harder to meet body blood circulatory demand which weakens the heart muscle. It can lead to left heart dysfunction and failure if no intervention is provided.

What is the epidemiology of Aortic Stenosis?

Approximately 300,000 people are diagnosed each year with severe aortic stenosis in the united states and more common in people over the age of 75. 

What causes Aortic Stenosis?

  • A buildup of calcium deposits in the narrow valve leaflet:  This is the most common cause of aortic stenosis in the united states and it is strongly associate with increasing age, high blood pressure, smoking, high cholesterol, and diabetes.
  • Congenital Heart Defect:  Aortic stenosis can develop in a baby of there is a defect in the numbers of aortic leaflet present. A normal aortic valve should have 3 leaflets and any variation will cause dysfunction of the aortic valve.
  • Rheumatic heart disease: This is the major cause of aortic stenosis worldwide. It occurs when strep throat leads to rheumatic fever causing the formation of scar tissue in the heart valves.
  • Radiation Therapy: people that undergo radiation therapy can end up with scar tissue formation leading to aortic valve stiffness and dysfunction.

What are the symptoms of Aortic Stenosis?

 Most people are asymptomatic in the early course of the disease. When symptoms are present, it usually occurs when the patient exerts themselves and includes:

  • Chest pain
  • Shortness of breath
  • Dizziness, lightheadedness or fainting

How to diagnose Aortic Stenosis?

The diagnosis of aortic stenosis should begin with a thorough history and physical diagnosis. A heart murmur or abnormal heart sound is usually heard through the stethoscope. ECG and stress tests may be ordered but they lack sensitivity and specificity. Transesophageal echocardiogram (TEE) is the single test that can confirm the diagnosis and determine the severity of the disease.

What are the treatments of Aortic Stenosis?

The treatment option of aortic stenosis will depend on the severity of the disease. Although transcatheter aortic valve replacement (TAVR) is the mainstay of therapy for aortic stenosis, symptoms may be managed with medications prior to surgery. Transcatheter aortic valve replacement (TAVR) procedures involve the insertion of a catheter through small incisions to access the valve leaflets and repair them or to access the damaged aortic valve and insert a new valve.

What are the indications for Aortic Valve Replacement?

  • symptomatic patients with severe AS defined by maximum aortic jet velocity over ≥4 m/s mean transvalvular pressure gradient ≥40 mmHg or aortic valve area ≤1.0 cm2
  • Asymptomatic patients with severe AS and LVEF <50 percent
  • asymptomatic patients with very severe AS and maximum aortic velocity ≥4.5 m/s
  • Asymptomatic patients with severe AS and decreased exercise tolerance or fall in systemic blood pressure with exercise

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