Aortic Stenosis

"Thanks to the echocardiogram, a thickened and calcified aortic valve can be visualized that opens little, as well as the functioning of the left ventricle. With the addition of doppler, the flows through the valve can be measured to assess the degree of stenosis".

DR. FELIPE HERNÁNDEZ HERNÁNDEZ
DIRECTOR. HAEMODYNAMIC AND INTERVENTIONAL CARDIOLOGY UNIT

Aortic stenosis is a disease that affects the aortic valve, narrowing the passage of blood. It occurs when the aortic valve does not open properly, preventing some of the blood from the left ventricle from passing to the rest of the body.

With increasing stenosis (decrease in the valve area), less blood passes from the ventricle to the rest of the body. The more severe the stenosis, the greater the effort of the left ventricle to overcome the imposed obstacle. The latter causes a hypertrophy (thickening) of the ventricular wall, which in turn becomes more rigid.

It can be caused by a progressive alteration that produces a calcification of a bicuspid valve present from birth, by the degenerative disease of the elderly patient that generates calcium deposits in the valve veils, or by a bacterial infection of the upper airways during childhood or adolescence that later affects the heart.

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What are the symptoms of aortic stenosis?

Symptoms may appear or worsen with exercise or any activity that raises the heart rate.

They can be triggered by pregnancy or other bodily stress, such as an infection in the lungs or heart, or other heart disorders. The main symptoms are:

  • Chest discomfort (angina).
  • Shortness of breath during or after exercise (dyspnea).
  • Fainting (syncope).

Once any of these symptoms are present, a physician should be consulted since the progression of the disease is more rapid.

In adults, symptoms usually develop between the ages of 20 and 50. In children and adolescents, symptoms may be present very early in growth.

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The most common symptoms are:

  • Chest pain.
  • Breathing difficulty.
  • Fainting.
  • Palpitations.

Do you have any of these symptoms?

You may have aortic stenosis

What are the causes of aortic stenosis?

The most frequent cause is degeneration due to calcium deposits in the valve veils.

In the population under 65 years of age the underlying cause is a bicuspid valve that predisposes to a more accelerated deterioration than that of a normal valve.

In the population over 65 years of age, the valve veils present an increase in calcium deposits, thus losing part of their natural mobility; this, in turn, generates a turbulent flow through the valve that increases calcium deposits in the veils, which thicken, perpetuating the cycle. 

The other cause of aortic stenosis is rheumatic fever. This condition of the upper airways, today has almost disappeared in Spain, thanks to the treatment and vaccine against infections produced by the Hemolytic Strep B. However, it is still frequent in African and Southeast Asian countries, where it is endemic and heart conditions are seen in children and adolescents.

What is the prognosis of aortic stenosis?

Generally, the prognosis of valve diseases is favorable with treatment, so it is very important to choose the time of surgical and interventional treatment that radically change the natural evolution of the disease.

The decision to intervene is made before irreversible sequelae occur on the heart itself, such as the exaggerated dilation of the cardiac chambers, especially the left ventricle, which can lead to the appearance of chronic heart failure despite surgical treatment.

How is aortic stenosis diagnosed?

For the diagnosis of aortic stenosis, the physician will listen to the heart and lungs with a stethoscope. A characteristic murmur may be heard that can radiate into the carotid (neck arteries) that are in continuity with the aorta. The carotid heartbeat may be decreased in amplitude.

The exam may also reveal an irregular heartbeat or lung congestion.

Blood pressure is usually normal.

Complementary tests for diagnosis are electrocardiogram, chest x-ray, echocardiogram and cardiac catheterization.

The chest x-ray may show an enlarged aorta. In some cases, aortic calcifications can be observed. If heart failure is present, fluid accumulation in the lung tissue may be seen.

How is aortic stenosis treated?

Treatment depends on the symptoms and condition of the heart and lungs.

People with mild or no symptoms at all may not need treatment and hospitalization may be necessary to make a diagnosis or to treat severe symptoms.

Medications used include diuretics, nitrates or beta-blockers. Digoxin can be used to treat atrial fibrillation. Anticoagulants are used to prevent blood clots from forming and traveling to other parts of the body.

The definitive treatment for aortic stenosis is valve replacement through heart surgery.

Valve surgery is open-heart surgery, that is, the heart's chambers or vessels must be opened to access the valves.

It is performed under general anesthesia, through an incision in the sternum.

During the operation, a heart-lung machine is used to perform the functions of the heart and the lung, oxygenating the blood and allowing the surgeons to stop the heart and work inside it.

It is a long surgery that lasts between 3 and 4 hours, and even longer, depending on the number of valves to be repaired or replaced.

Where do we treat it?

IN NAVARRE AND MADRID

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Specialists from the Department of Cardiology

The Department of Cardiology of the Clinica Universidad de Navarra is a center of reference in different diagnostic techniques and coronary treatments.

We have been the first center in Europe to place a pacemaker by means of a catheterization without the need to open the chest, for cases of severe heart failure.

The Cardiology Department of the Clinic collaborates with the Radiology and Cardiac Surgery Departments to achieve a quick and precise diagnosis of the patient.

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