Aortic Stenosis

What is Aortic Stenosis?

In aortic stenosis, the opening of the aortic valve becomes narrowed, and the left ventricle exerts increased pressure to drive blood through the opening. The added workload increases the demand for oxygen, while diminished cardiac output reduces coronary artery perfusion, causes ischemia of the left ventricle, and leads to heart failure.

Signs and symptoms of aortic stenosis may not appear until the patient reaches ages 50 to 70, even though the lesion has been present since childhood. Incidence increases with age. Aortic stenosis is the most significant valvular lesion seen among elderly people. About 80% of patients with aortic stenosis are male.

Causes of Aortic Stenosis

The most common cause of aortic stenosis is age-associated degeneration and calcification of the aortic valve, which often causes symptoms in elderly patients.

In the past, this type of degeneration of the valve was most common in patients who had rheumatic fever during childhood. Currently, rheumatic fever is rarely a cause of aortic valve degeneration.

Signs & Symptoms of Aortic Stenosis

The following are the most common symptoms of aortic stenosis. However, each child may experience symptoms differently. Symptoms may include:

• fatigue
• dizziness with exertion
• shortness of breath
• irregular heartbeats or palpitations
• chest pain

The symptoms of aortic stenosis may resemble other medical conditions or heart problems. Always consult your child's physician for a diagnosis.

Diagnostic Tests

Cardiac catheterization reveals the pressure gradient across the valve (indicating the severity of the obstruction), increased left ventricular enddiastolic pressures (indicating left ventricular function), and the location of the left ventricular outflow obstruction.

Chest X-rays show valvular calcification, left ventricular enlargement, pulmonary vein congestion and, in later stages, left atrial. pulmonary artery, right atrial, and right ventricular enlargement.

Echocardiography demonstrates a thickened aortic valve and left ventricular wall and, possibly, coexistent mitral valve stenosis.

Electrocardiogram (ECG or EKG) , a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle stress.

Treatment

Digitalis glycosides, a low-sodium diet, diuretics and, in acute cases, oxygen are used to treat patients with taeart failure. Nitroglycerin helps to relieve angina.

In children who don't have calcified valves, simple commissurotomy under direct visualization is usually effective. Adults with calcified valves need valve replacement when they become symptomatic or are at risk for developing left-sided heart failure.

Percutaneous balloon aortic valvuloplasty is useful in children and young adults who have congenital aortic stenosis and in elderly patients with severe calcifications. This procedure may improve left ventricular function so that the patient can tolerate valve replacement surgery.

Prevention Tips

Treat strep infections promptly to prevent rheumatic fever, which can cause aortic stenosis. This condition itself often cannot be prevented, but some of the complications can be.

Notify the health care provider or dentist about any history of heart valve disease before treatment for any condition. Any dental work, including cleaning, and any invasive procedure can introduce bacteria into the bloodstream. This bacteria can infect a weakened valve causing endocarditis.