Patients with systolic blood pressure of 140 and higher are deemed to have high blood pressure. The elderly are more prone to heart ailments, and aortic stenosis is a common heart valve disease seen among them.
Approximately 5-7% of the population in India above 65 years suffer from degenerative Aortic Valve Stenosis. It is observed that high blood pressure and cholesterol play a major role in causing aortic stenosis.
Aortic stenosis is a narrowing of the aortic valve of the heart, making it more difficult for the heart to pump blood into the aorta.
The aortic valve separates the left ventricle of the heart (pumping chamber) from the aorta (the major blood vessel in the body that delivers blood to the body). Aortic stenosis occurs when the aortic valve becomes narrow. Aortic stenosis primarily affects older people due to age-related damage and hardening of the aortic valve. This process can be accelerated in people who smoke cigarettes or have diabetes, kidney disease, high blood pressure, or high cholesterol.
Aortic stenosis may develop at a younger age in people born with an aortic valve that has only 2 leaflets (a bicuspid aortic valve) instead of the normal 3 leaflets or in people who have received chest radiation therapy.
Symptoms and Diagnosis
If left untreated, severe aortic stenosis can eventually culminate in heart failure, severe infections, and sudden death. From the onset of aortic stenosis symptoms, the average survival rate is around 50% at 2 years and approximately 20% at 5 years.
Aortic stenosis is regarded as the most prevalent valvular anomaly. It can arise due to congenital abnormalities or infections such as rheumatic fever or endocarditis. However, the primary cause of aortic stenosis is calcific degenerative disease, where calcium accumulates on the valve cusps as age advances. Affecting roughly 7% of individuals over 65, aortic stenosis is the most prevalent valvular heart condition globally.
Risks and Complications
Untreated aortic stenosis leads to severe complications, including heart failure, irregular heart rhythms (arrhythmias), and an elevated risk of infection. Seeking medical attention and discussing treatment options with the healthcare professional is the best option.
The treatment of severe aortic stenosis involves the replacement of the aortic valve.
There are two primary options:
Surgical Aortic Valve Replacement (SAVR):
Surgical aortic valve replacement is performed through open-heart surgery. During this procedure the heart is halted, and a heart-lung machine circulates blood throughout the body.
A surgeon substitutes the diseased aortic valve with a prosthetic valve.
Recovery from open-heart surgery usually spans from weeks to months.
Transcatheter Aortic Valve Replacement (TAVR):
Transcatheter aortic valve replacement is a less-invasive approach that replaces the aortic valve without requiring a chest incision to access the heart. The procedure involves the following steps:
A small incision is made in an artery or blood vessel, most often in the groin, to access the heart.
An artificial valve is compressed onto a catheter, then threaded through a blood vessel to the heart, displacing the diseased valve components.
The replacement valve is expanded, pushing aside the diseased portion of the aortic valve. X-ray guidance aids in positioning and placing the new valve. Patients who undergo TAVR generally experience a smoother recovery process and reduced discomfort.
The speed of recovery and return to daily activities depends on the individual’s overall health status.
Balloon Aortic Valvuloplasty:
This procedure involves placing a balloon attached to a catheter within the aortic valve and inflating it to expand the calcified valve opening and enhance blood flow. While it may offer temporary relief, it might not be a viable long-term solution.
Medical Management
Medical management is an option for patients who are unsuitable for surgery or choose to avoid it. While it can provide temporary relief, it might not be a sustainable long-term solution.
(Dr Naresh Purohit is Executive Member- Academy of Cardiovascular Sciences. The views and opinion expressed in this article are those of the author)