What is Aortic Stenosis
What is Aortic stenosis ? Simply, it is just a narrowing of the opening of the aortic valve. As a result, blood exiting the left ventricle will face a resistance to its flow through this narrowed valve.
In order to pump this blood through the stenotic valve, the left ventricle has to work harder resulting in thickening of its muscular wall. This thickened left ventricular muscle will require more oxygen, and hence more blood, to perform its function normally. Sometimes, during exercise, the coronary arteries are not able to deliver sufficient amounts o blood to this thickened ventricle and the patient can experience pain in the chest, fainting and in rare occasions sudden death may occur. As the disease progresses, the left ventricle will become weakened and heart failure occurs.
Causes Of Aortic Valve Stenosis
In developed countries Such as United states, the main cause is degeneration of the valve leaflets with aging resulting in calcium deposition and scarring of the valve leaflets or cusps. The condition usually starts around the 60′s, yet the patients may remain without symptoms till the 70′s. In developing countries, rheumatic fever is the main cause of aortic valve stenosis and i most cases others valves of the heart are also affected especially the mitral valve.
Symptoms And Diagnosis
Most common is chest pain which is usually noticed during exercise. Patients who developed heart failure usually suffer from easy fatigue and shortness of breath.
Aortic stenosis can occur due to a birth defect. In this case the valve may be composed of 2 cusps or leaflets instead of 3. Some children may develop severe symptoms in infancy while most of them experience problems in adulthood. As the child grows, the valve opening remains narrow and the left ventricle struggle to pump the blood. With time calcium deposits inside the valve which become very thickened and more narrowed.
In severe cases of aortic stenosis , sudden drop of blood pressure can result in fainting. fainting attack due to aortic stenosis are rarely preceded by lightheadedness.
Diagnosis of aortic stenosis is done through a physical examination . The doctor listen to a characteristic murmur with a stethoscope. The murmur can also be heard on the left side of the neck. Electrocardiography(ECG) is usually ordered to detect and pulse abnormalities and left ventricular wall thickness. The most important test to be done is an echocardiography. This test uses ultrasound waves and gives a detailed picture of the heart, its valves and chambers. The aortic valve area is measured as well as the pressure across the valve. The heart function is also evaluated.
Treatment of Aortic stenosis
Adult Patients with aortic stenosis require routine follow up visits to evaluate the progress of narrowing and the heart function. Decision to replace the valve surgically is based on the area of the valve as well as the patient symptoms. Patients with chest pain and shortness of breath may require earlier surgical intervention.
Before proceeding with surgery, heart failure should be treated using diuretics. Valve replacement is performed using a tissue valve or mechanical valve. Mechanical valves will require long-life therapy with anticoagulants such as coumadin. Antibiotics will be prescribed for patients with artificial valves before certain dental and surgical procedures to protect the valve from bacterial infection.
Children with aortic stenosis are treated either surgically or using balloon valvuloplasty. Balloon widening of the valve is performed using a catheter that is introduced through the groin area and advanced to the heart until it reaches the aortic valve. The balloon is then inflated to widen the valve.
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Yasser Elnahas
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