What is Aortic Stenosis?
Aortic stenosis is a condition in which the aortic valve responsible for regulating blood flow from the heart to the rest of body narrows, decreasing blood supply to the body and increasing strain on the heart. Affecting an estimated 300,000 people worldwide, aortic stenosis commonly results from causes including birth defects and progressive, age-related calcification of the valve. The latter reduces the pumping ability of the heart to push blood through the aortic valve to your body, and ultimately increases the chances of developing heart failure.
Aortic Stenosis Symptoms and Diagnosis
While sometimes asymptomatic, aortic stenosis symptoms can range from mild to severe, and include the following:
- Extreme fatigue with physical exertion
- Dizziness or fainting with physical exertion
- Pain, squeezing, pressure or tightness in the chest, usually occurring with physical exertion
- Rapid or irregular heartbeat (palpitations)
- Shortness of breath
Diagnosis could include a physician's physical exam for abnormal chest sounds (such as a heart murmur) and palpable vibrations when holding a hand over the heart. Tests to confirm the diagnosis may include an X-Ray, electrocardiogram, echocardiogram, and cardiac catheterization.
Medications to Treat Moderate Aortic Stenosis
While a physician might choose to simply monitor mild aortic stenosis, more serious cases may be managed through avoidance of strenuous physical activity as well as medications to help prevent heart failure. These medications include diuretics (water pills), beta-blockers, and nitrates. High blood pressure medications may also be prescribed.
Procedures to Treat Severe Aortic Stenosis
Mount Sinai Heart offers the full spectrum of procedure to treat severe aortic stenosis. This includes:
- Balloon valvuloplasty: This procedure involves threading a thin tube (catheter) with a deflated balloon at the tip from an incision in the groin through the arteries to the heart where it is then inflated in order to open or enlarge the aortic valve. The procedure typically lasts anywhere from 30 minutes to two hours and can cure many valve obstructions.
- Aortic valve replacement surgery: Traditionally performed as an open heart procedure, this operation involves removing the diseased valve and implanting a new one. There are two basic kinds of replacement valves: a bioprosthetic valve is made from an animal (such as a cow or pig), typically lasts 15 to 20 years, and does not require the patient to take blood-thinning medications; a mechanical prosthetic valve is a more durable synthetic valve that typically lasts 20 to 40 years and does require the use of blood-thinning medications.
- Transcatheter Aortic Valve Replacement/Implantation (TAVR / TAVI): A new, minimally-invasive technique, TAVR/TAVI does not require open heart surgery and provides hope to many patients with aortic stenosis who cannot tolerate open heart surgery due to frailty, old age and associated medical conditions. It involves threading a collapsed bioprosthetic valve through an incision in the leg to the heart, where the valve is expanded to push the diseased valve out of the way and assume its function. This inpatient procedure typically lasts about four hours. Aortic stenosis patients are often referred to Mount Sinai because we are the only hospital in the New York metropolitan area performing both types of TAVR/TAVI (CoreValve and Edwards Sapien Valve) available in the United States.