Aortic Valve Stenosis

Definition

Definition of Aortic Valve Stenosis
Aortic valve stenosis (AS) is a disease of the heart valves in which the opening of the aortic valve is narrowed. The aortic valve is the valve between the left ventricle of the heart and the aorta, which is the largest artery in the body and carries the entire output of blood.

Symptoms

Symptoms of Aortic Valve Stenosis
Symptoms related to aortic stenosis depend on the degree of valve stenosis. Most people with mild to moderate aortic stenosis do not have symptoms. Symptoms usually are manifest in those with severe aortic stenosis, although they can exist in those with mild to moderate severity as well. The initial presenting symptoms include progressive shortness of breath on exertion, which may be so subtle that the patient is unaware of them, and may cut down on exertion without being aware of his/her reduced capacity. More worrisome symptoms include syncope, chest pain, and frank heart failure.

Causes

Causes of Aortic Valve Stenosis
Aortic stenosis is most commonly caused by age-related progressive calcification of a normal (three-leafed) aortic valve (>50% of cases). Other causes include calcification of a congenital bicuspid aortic valve (30-40% of cases) and acute rheumatic fever (less than 10% of cases).

Diagnosis

Diagnosis of Aortic Valve Stenosis
Aortic stenosis is most often diagnosed when it is asymptomatic and can sometimes be detected during routine examination of the heart and circulatory system. Good evidence exists to demonstrate that certain characteristics of the peripheral pulse can rule in the diagnosis. In particular, there may be a slow and/or sustained upstroke of the arterial pulse, and the pulse may be of low volume. This is sometimes referred to as pulsus parvus et tardus. There may also be a noticeable delay between the first heart sound (on auscultation) and the corresponding pulse in the carotid artery (so-called 'apical-carotid delay'). In similar manner, there may be a delay between the appearance of each pulse in the brachial artery (in the arm) and the radial artery (in the wrist).

Treatment

Treatment of Aortic Valve Stenosis
Treatment is generally not necessary in people without symtoms. In moderate cases, echocardiography is performed every 1–2 years to monitor the progression, possibly complemented with a cardiac stress test. In severe cases, echocardiography is performed every 3–6 months. In both moderate and mild cases, the patient should immediately make a revisit or be admitted for inpatient care if any new related symptoms appear.

1. Aortic Valve Replacement: In adults, symptomatic aortic stenosis usually requires aortic valve replacement (AVR). AVR has been the standard of care for aortic stenosis for several decades.
2. Apicoaortic Conduit: Apicoaortic Conduit (AAC), or Aortic Valve Bypass (AVB), has been shown to be an effective treatment for aortic stenosis. There is long-term stability of the left ventricular hemodynamics after AVB, with no further biologic progression of native aortic valve stenosis. Once the pressure gradient across the native valve is substantially reduced, the narrowing and calcification of the native valve halts.
3. Balloon Valvuloplasty: For infants and children, balloon valvuloplasty, where a balloon is inflated to stretch the valve and allow greater flow, may also be effective. In adults, however, it is generally ineffective, as the valve tends to return to a stenosed state. The surgeon will make a small incision at the top of the patient's leg and proceed to insert the balloon into the artery and then inflate it to get a better flow of blood around the patient's body.

Prognosis

Prognosis of Aortic Valve Stenosis
Consult with your doctor.

Prevention

Prevention of Aortic Valve Stenosis
Some possible ways to prevent aortic valve stenosis include:

1. Take steps to prevent rheumatic fever: You can do this by making sure you see your doctor when you have a sore throat. Untreated strep throat can develop into rheumatic fever. Fortunately, strep throat can usually be easily treated with antibiotics.
2. Address risk factors for coronary artery disease: These include high blood pressure, obesity and high cholesterol levels. These factors have been linked to aortic valve stenosis, so it's a good idea to keep your weight, blood pressure and cholesterol levels under control if you have aortic valve stenosis. Lowering your cholesterol may be especially important in preventing aortic stenosis or slowing its progression.
3. Take care of your teeth and gums: There may be a link between infected gums (gingivitis) and infected heart tissue (endocarditis). Inflammation of heart tissue caused by infection can narrow arteries and aggravate aortic stenosis.