Aortic Stenosis – Causes, Symptoms and Treatment
Aortic stenosis is a narrowing of the aortic valve of the heart that restricts blood flow. It is one of the most common heart valve diseases and primarily affects older adults.
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Aortic stenosis is a narrowing of the aortic valve of the heart that restricts blood flow. It is one of the most common heart valve diseases and primarily affects older adults.
What is Aortic Stenosis?
Aortic stenosis is a narrowing of the aortic valve, the heart valve located between the left ventricle and the main artery of the body (the aorta). This narrowing obstructs the flow of blood from the heart into the systemic circulation. As a result, the heart must work harder to pump blood through the reduced opening, which can lead to progressive overload and weakening of the heart muscle over time.
Aortic stenosis is one of the most common acquired heart valve diseases in Western countries and predominantly affects people over the age of 65.
Causes
There are several underlying causes of aortic stenosis:
- Degenerative (calcific) stenosis: The most common form in adults. Calcium deposits accumulate on the valve leaflets over time, causing stiffening and narrowing.
- Congenital bicuspid aortic valve: A condition in which the aortic valve has two leaflets instead of the normal three. This structural abnormality increases the risk of early stenosis.
- Rheumatic fever: An inflammatory reaction following a streptococcal infection that can damage the heart valves and lead to scarring and narrowing.
Symptoms
In early stages, aortic stenosis often causes no symptoms. As the valve narrows further, the following symptoms may develop:
- Angina pectoris: Chest pain or pressure, especially during physical exertion
- Syncope: Dizziness or fainting episodes, particularly during activity
- Dyspnoea (shortness of breath): Initially on exertion, and later at rest in advanced stages
- Heart failure symptoms: Fatigue, leg swelling, and reduced exercise tolerance
The appearance of these symptoms is a critical warning sign. Without treatment, the prognosis deteriorates significantly once symptoms develop.
Diagnosis
Aortic stenosis is diagnosed using a combination of clinical examination and imaging tools:
- Cardiac auscultation: A characteristic heart murmur (systolic ejection murmur) is often audible with a stethoscope.
- Echocardiography (cardiac ultrasound): The gold standard for assessing the severity of stenosis, valve area, and cardiac function.
- ECG (electrocardiogram): May show signs of left ventricular hypertrophy (thickening of the heart muscle).
- Chest X-ray: Can reveal an enlarged heart or calcification of the valve.
- Cardiac catheterization: Used for precise pressure measurements and to evaluate coronary artery disease before intervention.
Treatment
While medications can help manage symptoms, they cannot reverse the narrowing of the valve. In severe aortic stenosis, a mechanical intervention is required:
Surgical Aortic Valve Replacement (SAVR)
Surgical aortic valve replacement (SAVR) is the traditional open-heart surgical procedure in which the diseased valve is replaced with a mechanical or biological prosthesis. It is particularly recommended for younger patients and those who are good surgical candidates.
Transcatheter Aortic Valve Implantation (TAVI)
TAVI (also called TAVR) is a minimally invasive procedure in which a new valve is delivered via a catheter -- most commonly through the femoral artery in the groin -- without opening the chest. This technique has become a well-established option for older patients or those at high surgical risk.
Balloon Valvuloplasty
In this procedure, a balloon catheter is used to stretch the narrowed valve opening. It is generally considered a temporary measure, as the stenosis typically recurs.
Prognosis and Outlook
Without treatment, the prognosis for symptomatic severe aortic stenosis is poor: the median survival after symptom onset is approximately two to three years without intervention. Following successful valve replacement, most patients experience a significant improvement in quality of life and life expectancy.
References
- Vahanian A et al. - 2021 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal, 2022.
- Nishimura RA et al. - 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease. Journal of the American College of Cardiology, 2014.
- Otto CM et al. - 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation, 2021.
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