Aortic Stenosis
What is Aortic Stenosis?
· Aortic Stenosis is one of the most common cardiovascular diseases in the Western world after hypertension and coronary artery disease (CAD).
· The aortic valve acts as a ‘gate’ enabling the flow of blood from the heart’s lower left chamber to the aorta, which is the main artery through which blood flows to reach the rest of the body
Aortic stenosis occurs when this valve narrows, thus resulting in abnormal blood flow through it.
· The severity of stenosis (narrowing) varies. In severe stenosis, the heart tries to adapt by increasing its left ventricular wall thickness, so as to become stronger and be able to push the blood through this narrowed passage. This is known as hypertrophy and serves to compensate for the increased stress of the left ventricular wall.
Diagram of the heart with aortic stenosis.
“Aortic stenosis occurs when this valve narrows, thus resulting in abnormal blood flow through it.”
What causes Aortic Stenosis?
· It is mainly caused by calcium deposits on the aortic valve (degenerative calcification). This restricts this ‘gate’ from opening over time.
· Several risk factors contribute to the development of aortic stenosis. Most notably, these include diabetes, hypertension, smoking and cholesterol.
What are the symptoms of Aortic Stenosis?
· Aortic Stenosis may be asymptomatic. However, as it progresses, it typically presents with a triad of symptoms:
o Shortness of breath and/or heart failure (50% of patients)
o Chest pain (35% of patients)
o Loss of consciousness (15% of patients)
· These symptoms are typically noted with exertion and usually prompt surgical intervention.
How is Aortic Stenosis diagnosed?
· Echocardiography is the imaging modality of choice. In basic terms, this is an ultrasound of the heart. Through it, the severity of Aortic Stenosis may also be determined.
· Computed tomography (CT) helps in determining the degree of valve calcification and it correlates with echocardiographic assessment and clinical outcome.
· Another imaging modality which may be used is Cardiac Magnetic Resonance Imaging (CMR) which aids in reliably detecting and measuring the valve area.
· Other diagnostic tests may include chest radiography, electrocardiography, cardiac catheterization, and exercise testing.
How is Aortic Stenosis managed?
· Asymptomatic patients should be followed up closely by with serial clinical examinations and should prompt their caring cardiologist if they develop any symptoms.
· In symptomatic patients, aortic valve replacement (AVR) is the treatment of choice. This is a surgical intervention during which the poorly working aortic valve is replaced with an artificial valve. Nowadays, such procedure can also be done through minimally invasive surgery using a small 1cm incision in the forearm or groin, through a procedure known as Transcatheter Aortic Valve Implantation (TAVI).
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This article was authored by Dr. Martina Agius, in collaboration with the Malta Heart Foundation