Aortic Stenosis is a common degenerative condition that affects the leaflets of the Aortic valve. It is estimated that approximately 1 patient in 8 over the age of 75 may be at risk of the condition.1

This condition can be caused by a stiffeneing of the leaflets of the valve, leading to narrowing of the aortic valve. This may reduce cardiac output and lead to symptoms such as shortness of breath, chest pain and dizziness on exertion.2

Untreated severe aortic stenosis can significantly affect a patients’ life span, with approximately 1 in 2 patients not surviving more than two years.3

Reference: 1-J AM Coll Cardiol 2013- Sept 10;62 (11) 1002-12 Osnabrugge RL # Reference: 2 http://www.hopeforhearts.om.au/aortic-stenosis Reference: 3 https://newheartvalve.com/au/understand-your-heart/what-is-aortic-stenosis/

Aortic Stenosis- (AS) causes a change in the leaflets that make up the Aortic valve

There are several reasons that the aortic valve becomes stiff and reduces the narrowing of the valve. The most common cause occurs as calcium deposits on the aortic valve over time resulting in the leaflets becoming stiff, reducing their ability to open and close effectively. Other common causes are:

Severity of AS is determined by the level of calcification of the aortic leaflets2

Reference: 1-2 https://newheartvalve.com/au/understand-aortic-stenosis/what-is-aortic-stenosis

Symptoms of Aortic Stenosis (AS)

Many of the symptoms of Aortic Stenosis (AS) can be commonly misunderstood to be related to ageing. However, they may be as a result of decreased cardiac output caused by a narrowing of the aortic valve.

Common symptoms include:

  1. Chest pain
  2. Shortness of breath
  3. Dizziness or Syncope1

These symptoms may start when performing activities such as cleaning, walking to the shops etc. Many of these symptoms may be relieved by resting. This may lead to people avoiding things that lead to these symptoms and may become socially isolated or require increased help from their families2.

Reference: 1 https://newheartvalve.com/au/understand-aortic-stenosis/risks-of-severe-aortic-stenosis/ Reference: 2 https://hopeforhearts.com.au/aortic-stenosis/
  • Chest pain

    Can be a result of a decreased cardiac output required when patient activity levels increase and the heart is unable to meet this oxygen requirement due to narrowed Aortic valve, leading to chest pain

  • Shortness of breath

    A reduced oxygen requirement can lead to patients feeling short of breath when performing activities around the house, shopping etc,

  • Dizziness or Syncope

    Occurs when there is a reduction on cardiac output to the brain during periods of exertion or activity, this may be relieved with rest

Reference: https://www.msdmanuals.com/en-au/professional/cardiovascular-disorders/valvular-disorders/aortic-stenosis

Diagnosis of Aortic Stenosis (AS)

When a Doctor has a suspicion of AS, patients may undergo a number of simple, non-invasive tests to confirm the condition. These are outlined below and include (but may not be limited to)

  • Heart Auscultation

    A stethoscope allows a doctor to listen to the heart and identify if there is a murmur present. The murmur may be result of abnormal blood turbulence within the heart. The presence of a murmur can potentially highlight an aortic valve problem that may need more investigations by a local doctor of referal to a cardiologist / cardiac surgeon.

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  • Chest X-ray

    A chest x-ray may be used to look at the heart size and diagnose any lung conditions that may mimic AS symptoms such as shortness of breath. Patients with aortic stenosis can become breathless when exerting themselves and there may be several reasons for this. A chest x-ray allows a local doctor to exclude any respiratory causes that may be related to breathlessness, such as asthma or emphysema for example. It also allows the visualisation of the size of the patient’s heart. In some cases, patients with aortic stenosis may develop heart failure due to the increased pressure within the heart, an enlarged heart may indicate this on chest x-ray. 1

    Reference: 1 https://hopeforhearts.com.au/aortic-stenosis/symptoms/ Free information Kit 

Cardiac Echocardiography

Echocardiography is a non-invasive ultrasound looking at the structures within the heart (such as heart valves) and can be used to measure blood flow through heart valves, identifying any structural abnormalities. There can be significant structural changes to the heart in the presence of aortic stenosis, such as an enlarged left ventricle and the left atrium. This may lead to symptoms of heart failure (shortness of breath etc). Echocardiography allows a cardiologist to measure the effective pumping mechanism of the heart as well as looking at the structures of the heart. It can also measure the size of the heart chambers and the thickness of heart walls. 1

Reference: 1 https://hopeforhearts.com.au/aortic-stenosis/symptoms/
  • Treatment options for Aortic Stenosis

    Multidisciplinary teams meet to review and discuss each patient’s results and decide on what is the most appropriate treatment option for each individual patient, with reference to any pre-existing conditions/ level of activity that each patient may have. These teams may include multiple medical/ nursing and allied health professionals, such as:

    1. Cardiologists
    2. Cardiac Surgeons
    3. Cardiac Anaesthetists
    4. Registered Nurses / Rehabilitation Specialists
    5. Geriatricians
    Reference: https://hopeforhearts.com.au/accredited-heart-team

Individualised treatment options may include

Balloon Valvuloplasty

Is a temporary treatment where a balloon is inflated within the diseased aortic valve and then deflated. This increases the size of the opening of the aortic valve, increasing blood flow. This may relieve symptoms temporarily, howevere it is widely accepted that symptoms may return.1

Surgical Aortic Valve Repair (SAVR)

This is the traditional method to replace the aortic valve. Cardiac surgeons will make an incision either in the middle of the sternum or a smaller incision in th echest wall to access the heart. The aortic valve is removed and a new tissue or mechanical valve inserted. This valve will begin to work immediately. The procedure may require a number of days in the ICU and then the ward prior to going home to complete the recovery process.2

Transcatheter Aortic Valve Implantation/Replacement (TAVI)

This technique uses a catheter to deliver a new tissue valve into the heart via the femoral arteries in the groin. In some cases, the catheter is introduced directly into the bottom of the heart. Once the catheter is inserted, it will be placed within the diseased aortic valve, and a balloon inflated, this pushed the old aortic valve out of the way, and leaves a new tissue valve, that begins working straight away. Patients may be discharged the follwing day to recover at home3

Reference: 1 - https://newheartvalve.com/au/explore-treatments/about-open-heart-surgery/ Reference: 2,3 - https://hopeforhearts.com.au/treatment

Treatment Options

Once the symptoms of aortic stenosis become more severe, the only effective treatment for the condition is to replace the valve.1 The multidisciplinary team will decide on the best treatment option for each patient. Treatment options include (but may not be limited to):

Balloon Valvuloplasty: is widely considered a temporary treatment that aims to increase the size of the aortic valve using an inflated balloon to relieve symptoms. In this procedure, a ballon in introduced into the heart, within the diseased aortic valve. A balloon is inflated, which stretches the diseased valve, therefore increasing the size of the opening of the valve. This may offer temporary relief of symptoms, however, most symptoms will likely return over time. 2

Surgical Aortic Valve Replacement (SAVR): Has been considered the only treatment option. This may include an open heart procedure where a patient may have an anaesthetic and be placed onto a heart-lung machine for the procedure. An incision may be made in the centre of the chest or through a smaller incision in the chest. The diseased aortic is surgically replaced by a new replacement valve, made out of tissue or metal (depending on your condition).3 The valve will work immediately. You may be in the hospital for a number of days, including some time in the Intensive Care Unit whilst you recover.4

Transcatheter Aortic Valve Implantation/Replacement (TAVI/R): is an alternative technique using a minimally invasive approach to replace the diseased aortic by accessing the aortic valve via the femoral artery in the groin 5. This catheter is introduced into the heart, and sits within the old aortic valve 6. Once the catheter is in place, a balloon is inflated, deploying the new valve to sit within the old valve, replacing it immediately. The new tissue valve will begin working straight away and can relieve symptoms much like the SAVR approach. Patients are usually discharged one – two days after the procedure.7

Reference: 1,3,5,6 https://newheartvalve.com/au/understand-aortic-stenosis/treatment-options Reference: 4,7 https://hopeforhearts.com.au/aortic-stenosis/treatment/

Aortic stenosis is a common heart valve condition, that can significantly impact on patients and their families. Please see your local Doctor to find out more information or click on the link below to learn more about Aortic Stenosis

The information contained within this site was gathered from Australia and New Zealands leaders in Aortic Stenosis treatment and information sources

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Aortic Stenosis treatment and patient information

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