Understanding Aortic Stenosis: Symptoms, Diagnosis, and New Treatment Options

Aortic stenosis, a progressive heart valve disease, is increasingly common, particularly among older adults. While often asymptomatic in its early stages, it can lead to serious complications, including sudden cardiac death. Fortunately, advancements in medical technology are offering new, less invasive treatment options.

What is Aortic Stenosis?

The heart has four valves that ensure blood flows in the correct direction. The aortic valve, located on the left side of the heart, controls blood flow from the heart to the aorta – the main artery supplying oxygen-rich blood to the brain and the rest of the body. Aortic stenosis occurs when this valve narrows, restricting blood flow.

“There are two on the right side and two on the left side,” explains Dr. Ahmed Elkaryoni, a cardiologist at Memorial Health. “One valve on the left side is called the aortic valve. That’s where blood would go everywhere…supplies all the organs.”

Causes and Progression

Aortic stenosis typically develops due to calcium deposits on the aortic valve with age. This causes the valve to become stiff and narrowed. The progression of the disease is often slow, starting as mild, progressing to moderate, and eventually becoming severe. Unfortunately, there are currently no medications to halt this progression.

“It takes years for the progression, but unfortunately, it’s a progressive disease,” says Dr. Elkaryoni. “Mild to moderate may grab years. moderate may take a few years until you reach severe. Once you hit the range of moderate to severe, every six months you should get an echocardiogram to evaluate for the severity.”

Symptoms of Aortic Stenosis

In its early stages, aortic stenosis often presents no noticeable symptoms. However, as the condition worsens, individuals may experience:

• Lightheadedness or dizziness
• Shortness of breath
• Chest pain
• Fainting (particularly with exertion)

“Some people do lose consciousness when it’s really severely tight because there is no blood flow going to their brain,” Dr. Elkaryoni notes.

Diagnosis

Doctors diagnose aortic stenosis using a variety of tests, including an echocardiogram, which uses ultrasound to visualize the heart and measure blood flow across the valve.

Treatment Options

Historically, the primary treatment for severe aortic stenosis was surgical aortic valve replacement (SAVR), an open-heart surgery. However, this invasive procedure isn’t suitable for all patients, especially the elderly.

“Because you’re not going to come to someone who’s 85 and say, ‘Hey, you do have a tight valve, we can open your chest for open-heart surgery to replace your valve,’ they’re going to say no,” explains Dr. Elkaryoni. “The surgeon is going to say also no, because this patient is not going to create it out of the operating room.”

A new, less invasive option, called Transcatheter Aortic Valve Replacement (TAVR), is now becoming available at hospitals like Memorial Health, making it the first hospital in southwest Oklahoma to provide the procedure. TAVR involves inserting a new valve through a small incision in the groin and guiding it to the heart using X-ray imaging.

“We go in the groin with tubes under X-ray guidance,” Dr. Elkaryoni describes. “We go up to the heart, we cross the classic aortic valve, and then we bring our catheter that’s holding the new valve across from that old aortic valve.”

Looking Ahead

With the advent of minimally invasive procedures like TAVR, more patients with aortic stenosis can receive effective treatment, improving their quality of life and potentially extending their lifespan. Regular check-ups, especially for those over 50, are crucial for early detection and management of this progressive heart condition.