Aortic valve stenosis, also known as aortic stenosis, occurs when there is a narrowing of the aortic valve in the heart. When the aortic valve becomes narrow, the valve is no longer able to fully open. This leads to an obstruction of blood from the heart to the aorta and throughout the rest of the body.
When there is an obstruction in the aortic valve, this means that the heart needs to work harder to pump blood throughout the rest of the body. Over time, this additional stress placed on the heart reduces the amount of blood that it is able to pump out. This results in a weakened heart muscle. When aortic valve stenosis becomes severe, the valve will most likely need to be replaced. If this condition is left untreated, it can lead to serious heart problems.
While symptoms of aortic valve stenosis can be mild or severe, they usually develop when the condition has become severe. Symptoms may include chest pain or tightness, feeling faint or fainting with exertion, shortness of breath, especially with exertion, fatigue, especially with exertion, heart palpitations, or a heart murmur.
It can be difficult to identify aortic valve stenosis because the signs and symptoms may not occur initially. It can also be difficult to identify because symptoms can be so mild that patients aren’t even aware that they are having symptoms. The condition is often first noticed during a routine physical exam in which your doctor hears an abnormal heart rhythm, such as a heart murmur. A heart murmur may be present much earlier than other symptoms appear.
If the heart becomes weak enough as a result of aortic valve stenosis, heart failure can develop. Symptoms of heart failure may include swollen ankles and feet, shortness of breath, and fatigue.
Aortic valve stenosis is caused by a narrowing of the aortic valve. This can happen as a result of various things that narrow the path between the heart and aorta. The condition may be caused by a congenital heart defect, calcium buildup on the valve, or rheumatic fever.
Risk factors for aortic valve stenosis:
• Age. Risk for aortic valve stenosis may be increased with age as well as the buildup of calcium deposits on heart valves.
• Aortic valve deformity. Some people have a narrowed aortic valve at birth or develop aortic valve stenosis later in life because they were born with a bicuspid aortic valve. A bicuspid aortic valve is when a person has with two flaps instead of three. People may also develop aortic valve stenosis if they were born with one flap (unicuspid aortic valve) or four flaps (quadricuspid aortic valve). This is much rarer. A bicuspid aortic valve is a major risk factor for aortic valve stenosis.
• Family history of aortic valve deformity. A bicuspid aortic valve can run in families. If you have a first-degree relative such as a parent, sibling or child, with a bicuspid aortic valve, you should get checked out to see if you have this same abnormality.
• History of rheumatic fever. Rheumatic fever can cause the flaps of your aortic valve to stiffen and fuse, which can cause aortic valve stenosis.
• Chronic kidney disease. Aortic valve stenosis is associated with chronic kidney disease.
The most common type of treatment for aortic valve stenosis is a transcatheter aortic valve replacement (TAVR). This type of treatment has traditionally been performed with open-heart surgery, but this is now a less invasive approach. A transcatheteraortic valve replacement involves replacing the aortic valve with a prosthetic valve via the femoral artery in your leg, otherwise known as the transfemoral artery, or the left ventricular apex of your heart.
During a transcatheter aortic valve replacement, the doctorinserts a catheter with a balloon at the tip in an artery in your leg or in a small incision in your chest. The catheter is then guidedto the heart and placed into then aortic valve. The balloon at the tip of the catheter has a folded valve around it which is then inflated. The balloon works by pushing the aortic valve open and stretching the valve open while expanding the folded valve into the aortic valve. Afterwards, the balloon is deflated and the catheter and balloon are then guided back out of the body. Another option is a self-expanding valve that may be inserted into the aortic valve. This option does not involve a balloon. And in some cases, a valve can be inserted via a catheter into a tissue replacement valve that needs to be replaced.
Transcatheter aortic valve replacement is most commonly for people who are suffering from a severe case of aortic valve stenosis. These people are at an increased risk of complications from aortic valve surgery. This minimally invasive procedure can improve severe aortic valve stenosis and its symptoms in people who are at increased risk of complications from aortic valve surgery. This type of procedure does come with risks though. Transcatheter aortic valve replacement has a higher risk of stroke and vascular complications compared to aortic valve replacement surgery.
So, who is a good candidate for transcatheter aortic valve replacement? This procedure is a good option for people for whom an open heart procedure is too risky. Most people in this category as usually older individuals, who are in their 70s or 80s. They also tend to have other health conditions that make them a better candidate for this type of procedure. While transcatheter aortic valve replacement is a newer type of procedure, it has been shown to be an effective option to improve quality of life in patients who have limited options to repair their aortic valve.