Aortic stenosis is one of the most common and serious valve disease problems. Aortic stenosis is a narrowing of the aortic valve opening. Aortic stenosis restricts the blood flow from the left ventricle to the aorta and may also affect the pressure in the left atrium.

 

Although some people have aortic stenosis  because of a congenital heart defect called a bicuspid aortic valve, this condition more commonly develops during aging as calcium or scarring damages the valve and restricts the amount of blood flowing through.

Does aortic stenosis always produce symptoms?

No. Many people with aortic stenosis, or AS, don't experience noticeable symptoms until the amount of restricted blood flow becomes greatly reduced.

 

Symptoms of aortic stenosis may include:

 

Chest pain

Rapid, fluttering heartbeat

Trouble breathing or feeling short of breath

Feeling dizzy or light-headed, even fainting

Difficulty walking short distances

Swollen ankles or feet

Difficulty sleeping or needing to sleep sitting up

Decline in activity level or reduced ability to do normal activities

It may be important to note the person suffering from AS may not complain of symptoms. However, if you or your family members notice a decline in routine physical activities or significant fatigue, it’s worth a visit to your health care provider to check for reduced heart function. Use our AS symptom tracker (PDF) to record your symptoms and frequency, and bring it to your next appointment to review with your doctor.

 

Stenosis animation

Infants and children who have aortic stenosis  due to a congenital defect may exhibit symptoms such as:

 

Fatigue upon exertion

Failure to gain weight

Poor or inadequate feeding

Breathing problems

The diagnosis of aortic stenosis is made mostly on physical examination and by echocardiography. The ECG in patients with aortic stenosis frequently shows left ventricular hypertrophy with strain and left atrial enlargement; however, these findings are non-specific for aortic stenosis.

 

The echocardiogram can also quantify aortic stenosis severity. Two-dimensional echocardiography can demonstrate a thickened aortic valve, reduced leaflet mobility and concentric left ventricular hypertrophy.

 

The severity of aortic stenosis is determined by measuring the aortic valve area (AVA) and calculating the pressure gradient between the left ventricle and the aorta on echocardiography. Aortic stenosis is described as mild, moderate, severe or critical based on these measurements.

 

The velocity of blood flow across the aortic valve, as determined by continuous wave Doppler, is used to calculate the transaortic pressure gradient using the modified Bernoulli equation:

 

Pressure gradient = 4v2

v = velocity

 

The AVA is calculated using the continuity equation:

 

A1 X V1 = A2 X V2

A2 = (A1 X V1) / V2

 

Where A1 is the area of the left ventricular outflow tract, V1 is the velocity of flow at the left ventricular outflow tract, A2 is the area of the aortic valve and V2 is the velocity of flow at the aortic valve. All of the above except A2 can be directly by 2D echocardiography (LV outflow tract area) or measured using continuous wave (CW) Doppler. The AVA is then calculated as shown above.

 

The chest radiography may reveal a normal cardiac size since the hypertrophy in aortic stenosis is concentric; however, once LV systolic failure occurs, cardiomegaly will be seen. Calcification of the aortic valve, pulmonary congestion, and post-stenotic dilation of the aorta are other non-specific findings.

 

Treatment – Aortic Stenosis

The only effective treatment for aortic stenosis is removal of the mechanical obstruction. To this end, only aortic valve replacement (AVR) has been shown to achieve this while reducing mortality. aortic valve replacement (AVR). Transcatheter aortic valve replacement is now FDA approved for those patients who are not surgical candidates due to age and comorbid medical conditions and is being performed successfully in many major medical centers. Aortic valve debridement via surgery or ultrasound debridement is a poor alternative to AVR. High rates or aortic regurgitation occur with these procedures and the aortic stenosis may recur in a large percentage of patients.

 

Pharmacological therapy is in general not effective in aortic stenosis. In fact, in critical aortic stenosis, many of the standard cardiovascular medications such as ACE inhibitors and beta blockers are considered to be relatively contraindicated when hypotension is present from low cardiac output.