Overview of Aortic Stenosis

There are two typical clinical scenarios where the aortic stenosis condition is common. The first one is caused by an abnormally congenital unicuspid bicuspid valve, not the tricuspid. The symptoms can manifest in adolescents or young people when the stenosis is serious however, they are more likely to manifest around the age of 50-65 as degeneration and calcification of the valve are evident. A dilated ascending aorta because of an inherent flaw in the anatomy of the root system along with the hemodynamic effect of the aortic jet that is eccentric could be associated with the bicuspid valve in around half of the patients.

The aorta can be coarctated. It can also be seen in a variety of patients with congenital  aortic stenosis. The children of patients with bicuspid valves have greater risk of having the condition in an aorta, valve and/or the two (up at 30% certain series). Another pathological process known as calcific or degenerative Aortic Stenosis, is believed to be linked to calcium deposition as a result of processes that are similar to those that occur in atherosclerotic blood vessel disease. Around 25% of patients who are over age 65 as well as 35% patients over 70 have evidence of thickening of the aortic valve (sclerosis). Approximately, 10-20% will develop to hemodynamically significant aortic stenosis in the course of 10 years.¹

Aortic stenosis is now the most frequent valve surgery in developed nations Many sufferers are older. The risk factors include hypertension, hypercholesterolemia, and smoking. Hypertrophic cardiomyopathy can also coexist with valvular orific stenosis.

Symptoms

Aortic valve stenosis can range in severity from moderate to serious. The signs and symptoms typically manifest when the valve narrows is extreme. Certain people suffering from aortic valve stenosis might not experience symptoms for years.

The signs and symptoms of aortic valve stenosis could be:

• The chest may be painful (angina) and tightness associated with the exercise
• A heart sound that is not normal (heart murmur) detected by Stethoscope
• Feeling faint , dizzy or fainting from activities
• Breathlessness, particularly after you’ve been active
• Fatigue, particularly during times of greater exercise
• A rapid, fluttering heartbeat (palpitations)
• Insufficient food intake (mainly for children with Aortic valve stenosis)
• Insufficient weight gain (mainly for children who have Aortic valve stenosis)

Aortic valve stenosis can result in heart failure. Heart failure symptoms include fatigue, breathlessness and swelling of feet and ankles.

When to seek medical help

If you experience an abnormal heartbeat or a heart murmur, your doctor might suggest visiting a specialist specially trained in conditions that affect the heart (cardiologist). If you experience any signs that could indicate an aortic valve obstruction, consult your physician.

Causes

The heart is equipped with four valves to ensure blood flow is in the right direction. These valves comprise Mitral Valve, the tricuspid valve as well as the pulmonary valve and the Aortic valve. Each valve is equipped with flaps (cusps or leaflets) that close and open every time a heart beat occurs. Sometimes, the valves do not fully close or open. If a valve does not fully close or open the blood flow can be reduced or blocked.

Aortic valve stenosis occurs when the aortic valve that connects the lower left chamber of the heart (left ventricle) and the aorta may not completely open. The blood vessel through which it circulates from the heart and into the aorta narrows (stenosis).

If the opening of the aortic valve is narrowed, your heart will have to perform harder to pump blood through the aorta throughout your entire body. The additional work required by the heart could make the ventricle of the left to become thicker and grow. The strain eventually can lead to an weakened heart muscle, which may eventually result in heart failure, as well as other serious issues.

The most common causes of aortic valve stenosis include:

• Heart defect that is congenital. Some children are born with an aortic valve which has just two cusps (bicuspid valve for the aortic) rather than three (tricuspid valve for the aortic). In rare cases, the Aortic valve could have only the one (unicuspid) as well as four (quadricuspid) cusps. Congenital heart defects like a bicuspid Aortic valve needs regular checks by a medical professional. The defect in the valve may not cause problems until you reach adulthood. If the valve starts to leak or narrow the valve may have to be replaced or repaired.
• A buildup of calcium on the valve. Calcium is a mineral that you find in your blood. Since blood flow is constantly through the aortic valve calcium deposits may build up on the valves in the heart (aortic valve calcification).The calcium deposits are unlikely to cause any harm. Aortic valve stenosis, which is related to aging and calcium deposits buildup typically isn’t a cause of concern until between 70 and 80. However, in certain people — specifically those who have an aortic valve defect that is congenital the calcium deposits can cause tightening and stiffening the cusps of your valve an earlier age. The calcium deposits found in the heart valve aren’t related to drinking calcium-rich drinks or taking calcium tablets. calcium-fortified drinks.
• Rheumatic disease. This complication of the strep throat infection could cause scar tissue to form on the valve of the aortic. Scar tissue may narrow the valve’s opening in the aortic region or cause rough surfaces on which calcium deposits could accumulate. Rheumatic illness can cause damage to the heart valve of more than and may affect multiple ways. Although rheumatic fever is not common within the United States, some older adults suffered from rheumatic fever when they were young children.

Risk factors

The risk factors for Aortic valve stenosis are:

• Older age
• Certain heart problems can manifest in the womb (congenital heart condition) like the bicuspid valve in the aortic chamber
• The history of infections can be detrimental to the heart
• Risk factors for heart disease like high cholesterol, diabetes or high blood pressure
• Chronic kidney disease
• The history of radiation therapy for the chest

Complications

Aortic valve stenosis could create complications, which include:

• Heart failure
• Stroke
• Blood forms clots
• Bleeding
• Heart rhythm problems (arrhythmias)
• Heart-related infections include endocarditis, for example.
• Death

Prevention

A few possible methods to avoid Aortic valve stenosis are:

• Take steps to avoid the onset of rheumatic fever. You can do this by ensuring that you consult your doctor if you experience an irritated throat. If not treated, strep throat may develop into rheumatic disease. However, strep thrush can be treated by using antibiotics. The rheumatic disease is most frequent in young children and adults.
• Aims at risk factors for coronary artery diseases. These include high blood pressure, obesity and cholesterol levels. These risks could be connected to aortic valve stenosis which is why it’s recommended to maintain your weight and blood pressure levels under control if suffer from aortic valve stenosis.
• Care for your gums and teeth. There may be the connection between infected gums (gingivitis) and damaged heart tissue (endocarditis). Inflammation of the heart tissue due to infection may reduce blood flow and aggravate the aortic valve’s stenosis.

If you are aware that you suffer from aortic valve deformity, your physician may suggest limiting intense exercise to avoid overloading your heart.

Diagnosis

Key Diagnostic Points

• Congenital bicuspid valve for the aortic (usually not symptomatic until middle age or older).
• “Degenerative” or calcific aortic the stenosis, similar risk factors to atherosclerosis.
• The visual appearance of an the aortic valve being immobile and an area of the valve that is less than 1.0 cm define severe disease and severe but low-grade aortic valve stenosis is therefore possible to detect. Echocardiography/Doppler is diagnostic.
• Surgery is typically recommended for signs. Percutaneous valve replacement is utilized more frequently.
• Surgery may be considered for patients suffering from severe aortic stenosis (mean gradient of more than 55 millimeters Hg) or when they are undergoing heart surgery due to other reasons (eg coronary bypass grafting (CABG)).
• BNP is a symptom for early LV myocardial dysfunction A high level of BNP suggests poor outcomes.

In order to determine whether you suffer from aortic valve the doctor will go over the signs and symptoms you have and discuss the medical background of you, and perform an exam. They will examine your heart using an stethoscope to determine whether there is a murmur in your heart that could be a sign of an aortic valve problem.

Tests

The doctor might order a series of tests to determine if aortic valve stenosis is the cause. Tests may also aid in determining the cause of the condition and its degree of severity.

Aortic valve stenosis tests can be:

• Echocardiogram. This test uses sound waves to produce images of your heart’s motion. A technician applies an instrument (transducer) hard against your skin and aims at an ultrasound beam that passes through the chest towards the heart. The transducer records the soundwave echoing from your heart and a computer transforms the reflections into images which the doctor can examine on the monitor. An echocardiogram shows your physician how blood flows across your heart, and valves. It will help you identify a weak heart muscle and assess the degree of aortic valve narrowing. If your physician requires an examination of the aortic valve, a transesophageal echocardiogram can be performed. In this procedure the flexible tube that contains the transducer is placed down the throat, and then into the stomach.
• Electrocardiogram (ECG or EKG). The test is painless and monitors the electrical activity of your heart with the help of small sensors (electrodes) that are attached to your chest, arms and, occasionally legs. An EKG The test can reveal the presence of enlarged chambers in your heart as well as heart disease and irregular heart rhythms.
• Chest Xray. A chest X-ray will help your doctor figure out whether your heart is inflamed and enlarged, which is a sign of the condition of aortic valve stenosis. It may also reveal an increase in the size of your aorta, as well as the buildup of calcium on the Aortic valve.
• Tests for exercise or stress test. Exercise tests help your doctor determine if symptoms and signs of aortic valve diseases occur during exercise. These tests will help you assess the seriousness of the problem. If you’re unable to exercise, medication with similar effects to exercise for your heart could be prescribed to finish the test.
• The Cardiac Computerized Tomography (CT) scanning. A cardiac CT The scan blends several scans of X-rays to offer more precise cross-sectional views of the heart. Doctors may use cardiac CT To determine the dimensions of your aorta. examine your aortic valve with greater precision.
• Cardiac MRI . A cardiac MRI Utilizing radio waves and magnetic fields to produce detailed images of the heart. This test is able to assess whether you are suffering from a illness and to determine the size of your aorta.
• Cardiac catheterization. This test isn’t typically used to identify Aortic valve problems, but it can be utilized if other tests fail to determine the cause or determine the extent. It could also be utilized prior to surgery on the aortic valve in order to ensure that the arteries that supply to the muscles of the heart (coronary arteries) aren’t blocked. Through this process, your physician runs a small tubing (catheter) through an artery in your groin or arm, and then guides it towards an artery within your heart. Sometimes dye is injected into the catheter in order to help the arteries appear more clear on an X-ray (coronary angiogram). A coronary angiogram provides your doctor an accurate view of the heart arteries and the way your heart works. In the course of the examination, the doctor will also determine the pressure in the chambers of your heart.

Treatment

The treatment for aortic valve stenosis is based on the symptoms and signs as well as the severity of your condition.

If you are experiencing only mild symptoms, or none at all You may require your health condition checked regularly by a doctor. Your doctor might suggest healthy lifestyle changes and medication to manage symptoms or decrease the chance of developing complications.

Other procedures or surgeries

It is possible that you’ll require surgery to fix or replace the damaged Aortic valve, even though you aren’t suffering from symptoms. Aortic valve surgery could be performed in conjunction with other heart surgeries.

Repair or replacement of an aortic valve is typically performed through a cut (incision) within the chest. Alternative approaches to surgery may be available. Check with your doctor to see whether you’re eligible to undergo these surgeries. Aortic valve surgery could be performed simultaneously with other heart surgeries.

The options for surgery to treat Aortic valve stenosis are:

• Repair of the aortic valve. To repair an Aortic valve, surgeons cut valve flaps (cusps) that are fused. But, surgeons seldom replace an aortic valve in order to treat the condition of aortic valve stenosis. Aortic valve stenosis generally necessitates aortic valve replacement.
• Balloon valveoplasty. This procedure can be used to treat aortic valve narrowing in infants and kids. But, the valve is more likely to shrink after the adult who has undergone the procedure, which is why it’s generally only recommended for adults who are unfit to undergo surgery or are in the process of getting a valve replacement in the event that they require more procedures for treating the valve that has narrowed as time passes. In this process the doctor inserts a thin, long tubing (catheter) with balloons on the tips into an artery located in the groin or arm, and then guides it towards the valve in your aortic. Once the catheter is in position the balloon will be inflated, which opens the valve’s opening. It is deflated and the balloon and catheter are taken out.
• Replacement of the aortic valve. Aortic valve replacement is usually required to treat the condition of aortic valve stenosis. When you undergo aortic valve replacement your surgeon will remove the valve that is damaged and then replaces it with a new mechanical valve or one made of pig, cow or human cardiac tissues (biological tissue valve). The biological valves for tissue degrade in time and eventually require replacement. Patients with mechanical valves may have to take blood-thinning medication throughout their lives to avoid blood clots. Your physician will explain to you the advantages and dangers for each type of valve.

• Transcatheter aortic valve repair (TAVR). This procedure is less invasive and could be an option for patients who are at a moderate or high-risk of complications following surgical Aortic valve replacement. ²In TAVR The doctor will put a catheter in your chest or in your leg to lead the catheter to your heart. An additional valve placed through the catheter and then guided through your heart. A balloon could increase the size of the valve, or certain valves may self-expand. Once the valve has been implanted then doctors will take the catheter from the blood vessel. Doctors can also carry out an intervention using a catheter to implant a replacement valve inside the biological tissue valve that has stopped working in a proper manner.³