Aortic Stenosis

December 20th, 2017

What is Aortic Stenosis (AS)?

Aortic stenosis (AS) is a serious and potentially life threatening condition that develops when there is a buildup of calcium on the aortic valve. This causes the valve to become stenotic (stiff) and the opening smaller. As a result, your heart has to work harder and less blood can be delivered to your body. As the blood passes through the stenotic valve, it creates a sound called a murmur. Your doctor might hear this sound when using a stethoscope to listen to your heart. This sound may be one of the first indications that you have a heart valve problem.

Normal blood flow through your heart

Your heart has four chambers and four valves. The valves prevent the blood from flowing backward as it travels through the heart. Normally, unoxygenated blood enters the right atrium and travels through the tricuspid valve into the right ventricle. Blood leaves the right ventricle through the pulmonic valve to enter the lungs for reoxygenation. Once the blood has been replenished with oxygen, it returns to the heart via the pulmonary vein and enters the left atrium.Your blood will leave the left atrium by passing through the mitral valve to enter the final chamber of the heart, the left ventricle. The left ventricle is responsible for pumping the oxygen-rich blood through the aortic valve to your body.

What causes AS?

  • Increased age
  • Birth Defects
  • Rheumatic Fever
  • Radiation Therapy

What are the Symptoms of AS?

Although some people do not report any symptoms, it is more likely that they have decreased their activity as their aortic stenosis worsened. More commonly you will experience one or more of the symptoms below.

  • Shortness of Breath
  • Lightheadedness or dizziness
  • Passing out or fainting
  • Palpitations or fast heart beat
  • Chest pain or discomfort
  • Fatigue
  • Decreased activity tolerance
  • Swelling of the lower legs or feet

What happens if AS goes untreated?

As the aortic valve becomes more stenotic or stiff, your heart must work harder to deliver blood to the rest of your body. Over time this causes your heart muscle to become weak, eventually resulting in heart failure. After the onset of symptoms, patients with severe aortic stenosis have a survival rate as low as 50% at 2 years and 20% at 5 years without aortic valve replacement.

What’s Next?

Aortic stenosis is a complex medical condition best treated by a comprehensive team that can decide which approach is best based on a person’s medical and overall physical condition. A multidisciplinary team of specialists from Prairie Heart Institute, SIH Medical Group Cardiothoracic Surgery and Carbondale Memorial Hospital partner to develop individualized care plans while continuously working together to provide patients with innovative and effective cardiovascular care.

If you or a loved one has been diagnosed with AS or told that you have a murmur you can call 618.529.4455 to request an evaluation with our Heart Valve Clinic.

By consulting with our Heart Valve Team you will have access to world class, highly skilled interventional and non-invasive cardiologists, cardiac surgeons, cardiovascular imaging specialists, cardiac anesthesiologists, and cardiac nurses.

What can I expect if my primary care provider refers me to the Heart Valve Clinic?

During the initial consultation a Cardiologist will perform a comprehensive history and physical exam.

Family history: it is helpful if you gather the information about your family (parents-siblings) prior to meeting your cardiologist as many conditions run in families.

Medical History: your cardiologist will ask you about your overall health, past surgeries, significant illnesses, current medications, and allergies.

Your cardiologist will perform a physical exam which will include listening to your heart for murmurs. This is the sound made as blood passes through your heart valves and can indicate a diseased valve.
Testing may be ordered to assess the heart valves and overall heart function.

Electrocardiogram (EKG): The EKG will record your hearts rate and rhythm by documenting the electrical condition in your heart. Many abnormalities within the heart will result in changes in the electrical condition.

Echocardiogram: An echocardiogram is a sound wave test performed on your heart that allows the cardiologist to assess the function of your heart muscle and valves.
After your initial exam and testing are complete, your cardiologist will review your case with the Structural Heart Team and advice treatment options.

Observation and possibly medication such as a diuretic (water pill) only if the AS is mild. You will also be scheduled for a follow up visit within 3-6 month to assess any changes in your heart valve. If you notice any change in your symptoms or exercise ability you should contact your cardiologist.

Consultation with a Cardiothoracic Surgeon for possible open heart surgery to replace the aortic valve. Surgical Aortic Valve Replacement (SAVR) through open heart surgery is a very common treatment for aortic stenosis. SAVR has been performed for many years. During SAVR, the surgeon opens the chest cavity, removes the diseased aortic valve and replaces it with either a mechanical valve (made from man-made materials) or a biological valve (made from animal or human tissue).

Consultation with the Heart Valve Team (Structural heart team) to be evaluated for TAVR (Transcatheter Aortic Valve Replacement) where the new valve is implanted though a catheter without open heart surgery. Transcatheter Aortic Valve Replacement (TAVR) may be an alternative for people who have been diagnosed with severe symptomatic aortic stenosis and who are high-risk or too sick for open heart surgery. This less invasive procedure allows a new valve to be inserted within the native, diseased aortic valve. The TAVR procedure can be performed through multiple approaches; however the most common approach is the transfemoral approach (through an incision in the leg). With the heart still beating, a collapsible heart valve inside the catheter is guided into the chest. This valve is only about the diameter of a #2 pencil. Once inside, the replacement valve is expanded, pushing aside the damaged valves. The replacement valve is then secured into place, where it begins to function immediately. The catheter is then removed. Because the procedure is minimally invasive and requires virtually no cutting, most patients can expect an in-hospital recovery time of three days or less.

Our team will guide you and your family through the evaluation process and will be available to assist in coordinating your care every step of the way.
You can find out more about our valve team at sih.net/prairie.