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Aortic Stenosis

Aortic Valve Stenosis Treatment in Delhi, India

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Overview

Aortic stenosis is a heart disease which occurs when the aortic valve's opening becomes narrow or doesn't open properly. The aortic valve plays a major role in pumping blood to the aorta, the biggest blood vessel found in the body. 

Types

There are two types of aortic stenosis, including: 

  • Congenital aortic stenosis: In this type, aortic valve disease occurs since birth. The aortic valve is not appropriately formed in this condition. The valve develops two flaps or leaflets instead of three. Symptoms of congenital aortic stenosis may not appear until adulthood. 
  • Acquired aortic stenosis: This type of aortic stenosis appears later in life. It usually occurs when there is calcium built on the edges of aortic valve flaps, causing them to fuse.

Symptoms

Symptoms of aortic stenosis occur when there is a severe narrowing of the aorta valve. These may include: 

  • Abnormal heart sound (heart murmurs)
  • Chest pain or tightness
  • Dizziness 
  • Shortness of breath
  • Rapid heartbeat
  • Heaviness in chest
  • Loss of consciousness
  • Fatigue upon exertion
  • Failure to gain weight
  • Unable to eat properly

Causes

Multiple reasons may prevent the aortic valve from functioning correctly. The valve opens and closes every time with each heartbeat. When the aortic valve opening becomes marrow, the heart works harder to pump blood. Here are some causes that may cause aortic stenosis:

  • Congenital Defects: The condition may be present since birth in some people due to congenital deformities, which cause the irregular formation of leaflets or flaps of the aorta valve. 
  • Build up of calcium: Calcium is an essential mineral present in the blood. With regular blood flow, some of the calcium deposits on the aortic valve prevent them from functioning correctly. However, it usually occurs sometime after the age of 60. 
  • Rheumatic Fever: This is one of the most common causes of aortic stenosis in younger individuals. Rheumatic fever may damage the heart valve, which can narrow the aortic valve. 

Diagnosis

The doctor will perform different physical exams and will ask about symptoms, risk factors, and family history (if any). The doctor might also conduct some tests:

  • Electrocardiogram (ECG or EKG): ECG records the electrical signals and rhythm of the heart. 
  • Echocardiogram: As the primary diagnostic tool, this test utilises sound waves to generate a visual representation of the heart, helping in the identification of heart muscle damage caused by inadequate blood flow.
  • Stress Test: It is used to evaluate heart function during exercise, such as walking on a treadmill or cycling. During this time, ECG and blood are recorded along with other tests. 
  • Chest X-ray: This imaging test captures images of the heart and lungs, allowing for the examination of other potential conditions that could account for the symptoms.
  • Cardiac catheterisation: In this procedure, a catheter (thin tube) is inserted through a blood vessel in the arm or leg and guided to an artery in the heart to obtain diagnostic information.
  • Coronary angiography: During this examination, a dye is injected into the heart's blood vessels, and an X-ray is taken to produce a detailed image that provides insight into the condition of the blood vessels.
  • Cardiac computerised tomography (CT) scan: In this test, the patient lies down on a table inside a machine that has an X-ray tube inside. The machine then rotates around the body and collects images of the heart and chest. This helps to show whether the heart arteries are narrowed or not. 

Treatment

If a patient has mild symptoms, then watchful waiting is one treatment with regular doctor appointments. Apart from this, there are some other treatments for aortic stenosis, including:

Medications

Medications cannot treat aortic stenosis. However, they can help slow down the progression and reduce the complexity that occurs due to the condition. The doctor may prescribe the following medicines for this condition: 

  • Nitrates relax and widen blood vessels
  • Beta-blockers slow down the heart, so it doesn't have to work harder
  • Blood thinners or antiplatelet medications to prevent blood clots
  • Statins to lower blood cholesterol
  • Medications to control high blood pressure, diabetes, and more. 

Surgery

In case the patient is suffering from severe aortic stenosis, the doctor may recommend the following surgery to treat the condition, including: 

  • Balloon Valvuloplasty: The procedure is beneficial to treat aortic stenosis in children and infants. The cardiac surgeon inserts a catheter with a balloon on the tip into the artery in the arm or groin during the procedure. The cardiologist then guides it to the aortic valve and places the balloon, which is then inflated. This allows widening of the valve opening. The specialist then deflates the balloon and removes it from the patient's body. 
  • Aortic Valve Replacement: In this procedure, the surgeon replaces the damaged aortic valve with a mechanical valve. The surgeon may also use a biological tissue valve made from cow, pig, or human heart tissues. 
  • Transcatheter aortic valve replacement (TAVR): TAVR is a less invasive procedure and has better recovery than other surgeries. The surgeon inserts a catheter with a balloon on the tip into the artery in the arm or groin during the procedure and guides it to the aorta valve. The cardiologist then replaces the defective valve. 

Risk factor

Some of the factors also increase the risk of aortic stenosis, including:

  • Certain congenital heart diseases
  • Chronic kidney problems
  • Previous heart infections
  • Rheumatic fever
  • History of radiation therapy 
  • Diabetes
  • High blood pressure
  • Older age
  • High blood cholesterol
  • Family history of heart disease

Prevention

There are some ways to reduce the risk of developing aortic stenosis. These include:

  • Quit Smoking
  • Eat a healthy diet
  • Lose weight 
  • Practice good dental hygiene
  • Reduce stress level
  • Limit alcohol consumption
  • Increase physical activity 
  • Monitor heart conditions
  • Control BP and diabetes
  • Take medicines regularly as prescribed

Complication

Aortic stenosis can result in the following complications

Outlook

The prognosis and outlook for aortic stenosis depend on the type of treatment. People with no symptoms generally have a good outlook. People with moderate or mild symptoms also have a positive outlook. The mortality risk for surgical procedures like valve replacement, TAVR and balloon valvuloplasty is less than 3 per cent. 

Review

Reviewed by Dr. Sunil Kumar Wadhwa, Principal Consultant – Cardiology, Cardiac Sciences, Cardiac Electrophysiology-Pacemaker, Interventional Cardiology.


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