Tag Archives: Aortic Valve Stenosis

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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Congenital Aortic Valve Stenosis

When the aortic valve, which allows the oxygenated blood in the left ventricle to flow into the major artery aorta, is narrowed, it is referred to as aortic valve stenosis.

  • The heart has to work more forcefully to pump the blood out into the aorta through the narrowed valve.
  • A heart murmur is the usual symptom of aortic valve stenosis. Shortness of breath, pain in the chest, and fatigue, are the other symptoms that may occur in some cases.
  • The typical heart murmur and the other symptoms lead to diagnosis.
  • The valve has to be widened surgically, or in some cases, surgery is needed to replace the valve.

When the aortic valve is narrow, the left ventricle has to contract with higher than normal force to push the oxygenated blood into the aorta which supplies to the rest of the body. To maintain adequate blood supply, the heart pumps the blood at high pressure. Often, adequate amount of oxygenated blood does not reach the different parts of the body.

In most cases of congenital aortic valve stenosis, a typical heart murmur may be the only symptom present, especially in young children. As they get older, other symptoms such as shortness of breath and pain in the chest may be felt. Fatigue and occasional fainting may occur. Adolescents with aortic valve stenosis are at risk of sudden death, probably due to irregular heart rhythm resulting from the poor blood supply to the coronary artery which goes to the heart muscle. Irritability, pallor or paleness of skin, fast heart rate, sweating, extreme shortness of breath, and decreased blood pressure, are observed in some infants with aortic valve stenosis.

When a typical heart murmur is detected, or when a child has symptoms, congenital aortic valve stenosis is suspected and further investigations are conducted. Cardiac catheterization may help determine the extent and severity of stenosis.

Surgical options include widening of the valve, as well as valve replacement. Balloon valvulotomy is a procedure used to open up the valve surgically. Severe stenosis and associated symptoms may necessitate the implantation of an artificial valve. Since the risk of clot formation is high with artificial valves, an anticoagulant like warfarin should be taken by those who have them implanted. When heart failure results from aortic valve stenosis, immediate surgical intervention is necessary. Balloon valvuloplasty or surgical correction is done along with drug treatment.

Watch This Video About Congenital Bicuspid Aortic Valve Stenosis:

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