What is Aortic Stenosis?

Aortic stenosis (AS) occurs when the aortic valve, responsible for controlling blood flow from the heart to the rest of the body, becomes narrowed or fails to open properly. This narrowing restricts blood flow, forcing the heart to pump harder to supply blood to the body. Over time, the extra strain on the heart can lead to its enlargement and weakening, potentially culminating in heart failure. AS can vary in severity, with some individuals experiencing no symptoms until the condition progresses significantly.

Common Symptoms of Aortic Stenosis

Symptoms of AS typically emerge as the narrowing of the valve becomes severe. These symptoms may include abnormal heart sounds (heart murmurs), chest pain or tightness during physical activity (angina), dizziness or fainting during exertion, shortness of breath upon exertion, fatigue, rapid or irregular heartbeat (palpitations), and poor appetite or inadequate weight gain, especially in children with AS.

Causes of Aortic Stenosis

AS can arise from various causes:

• Congenital Heart Defects: Some individuals are born with an aortic valve that has only two cusps instead of the usual three, which may not cause issues until adulthood.
• Advancing Age: AS commonly affects older individuals due to the gradual stiffening and calcium buildup on the valve.
• Calcium Build-up: Deposits of calcium can accumulate on the valve, causing it to become stiff and narrow.
• Genetic Predisposition: Certain genetic variations passed down from parents may increase the likelihood of developing AS.
• Rheumatic Heart Disease: Scar tissue formation on the aortic valve, resulting from complications of strep throat infection, can lead to narrowing.
• Radiation Exposure: Exposure to certain forms of radiation may elevate the risk of developing AS.

Diagnosis and Early Detection

AS can be diagnosed through a combination of physical examination and tests such as electrocardiography (ECG), echocardiography, and a six-minute walk test. These diagnostic tools help assess the severity of AS and its associated symptoms, guiding further management.

Treatment Options for Aortic Stenosis

Treatment options include:

• Medications: These can help alleviate symptoms, but they may not address the underlying issue.
• Balloon Valvuloplasty (BAV): A minimally invasive procedure that involves inflating a balloon within the narrowed valve to widen it, providing temporary relief.
• Surgical Aortic Valve Replacement (SAVR): A traditional open-heart surgery where the damaged valve is replaced with either a mechanical or biological tissue valve. It offers a long-term solution but involves a more extensive recovery.
• Transcatheter Aortic Valve Replacement (TAVR): A less invasive procedure where a new valve is inserted via a catheter, often through the groin, and positioned within the diseased valve. It is suitable for individuals who are at high risk for open-heart surgery or prefer a quicker recovery.

1. Medications: In cases where AS is mild or asymptomatic, medications
   may be prescribed to alleviate symptoms and improve overall heart
   function. These medications may include:
2. Blood Pressure Medications: Drugs such as beta-blockers or calcium channel blockers may be prescribed to lower blood pressure and reduce the strain on the heart.
3. Diuretics: Also known as water pills, diuretics help eliminate excess fluid from the body, relieving symptoms of fluid buildup such as swelling and shortness of breath.
4. Cholesterol-lowering Medications: Statins may be prescribed to lower cholesterol levels and reduce the risk of plaque buildup in the arteries, which can worsen AS.

While medications can provide symptomatic relief, they may not address the underlying cause of AS and are typically used in conjunction with other treatment modalities.

1. Balloon Valvuloplasty (BAV): Balloon valvuloplasty is a minimally invasive procedure performed to widen the narrowed aortic valve using a balloon-tipped catheter. During the procedure, the catheter is guided to the site of the narrowed valve, and the balloon is inflated to stretch the valve open. This temporary relief can improve blood flow and alleviate symptoms in select patients. However, the effects of balloon valvuloplasty may not be long-lasting, and the procedure is often considered a temporary measure or a bridge to more definitive
   treatment.
2. Surgical Aortic Valve Replacement (SAVR): Surgical aortic valve replacement involves the removal of the diseased aortic valve and its replacement with either a mechanical or biological tissue valve. This open-heart surgery is performed under general anesthesia and requires a sternotomy (opening of the chest). SAVR is considered the gold standard treatment for severe AS and offers long-term relief of symptoms and improved survival rates. However, it involves a longer recovery period and carries inherent risks associated with surgery.
3. Transcatheter Aortic Valve Replacement (TAVR): Transcatheter aortic valve replacement is a less invasive alternative to SAVR, particularly suitable for high-risk or elderly patients who may not
   tolerate traditional surgery well. During TAVR, a collapsible valve is inserted into the body through a catheter, usually via the femoral artery in the groin, and guided to the site of the narrowed valve. Once in position, the new valve is expanded, pushing aside the diseased valve and restoring proper blood flow. TAVR offers several advantages over SAVR, including shorter hospital stays, quicker recovery times, and reduced risk of complications.

Aortic stenosis is a serious condition that requires appropriate treatment to manage symptoms and prevent complications. If you suspect you may have AS or are experiencing symptoms, seek medical attention for evaluation and persona