Aortic Stenosis: What You Need to Know

Aortic stenosis is a type of heart valve disease. The aortic valve opens to allow blood to flow forward to the body and closes tightly so blood does not leak backwards into the heart. Aortic stenosis is a narrowing of the aortic valve opening. It prevents blood from flowing easily and makes the heart work harder. Read on to learn what you need to know about aortic stenosis.

Aortic stenosis is the most common heart valve disease in the United States. The main forms of it are congenital (from a birth defect) and age-related (degenerative) aortic stenosis. About 25% of people older than 65 have some form of mild aortic valve disease. Some will progress to severe aortic stenosis. In fact, age-related aortic stenosis is the most common reason for aortic valve surgery.

Degenerative aortic stenosis results from a valve that wears out with age. The process is similar to atherosclerosis. The body deposits calcium and fats on the valve. This causes the valve to become stiff and thick, which restricts how the valve opens. As the disease progresses, the heart must pump harder to move blood through the narrowed opening.

Problems with the aortic valve can show up as a heart murmur on a physical exam. A heart murmur is an unusual sound during a heartbeat that you can hear with a stethoscope. Symptoms can also suggest a problem with the aortic valve. Symptoms of aortic stenosis include shortness of breath, chest pain, dizziness, and fainting. If your doctor suspects aortic stenosis, you may need other tests including an EKG (electrocardiogram) and an echocardiogram.

The risk factors for aortic stenosis are very similar to atherosclerosis (smoking, high blood pressure, high cholesterol, and diabetes). For most individuals, however, aortic stenosis can’t always be prevented. But there are things you can do to prevent complications from the disease. Start with a heart-healthy lifestyle. Make sure you treat related diseases, including high blood pressure, high cholesterol, obesity, and diabetes. Get regular medical and dental care. Ask your doctor if you need premedication with antibiotics before dental procedures.

Medicines can’t reverse, stop or cure aortic stenosis, but they can be useful in some cases. They can help treat symptoms of valve disease and protect the heart from failing. So doctors may recommend medicines for mild disease or in people who can’t have surgery. But aortic stenosis tends to progress. Eventually, medicines may no longer protect the heart and symptoms may get worse.

Surgery to repair or replace the valve is the only way to cure aortic stenosis. In most cases, surgery involves replacing the aortic valve. There are a few surgical options, including open heart surgery and minimally invasive procedures, such as TAVR (transcatheter aortic valve replacement). Each has advantages and disadvantages. In general, doctors recommend surgery when symptoms and narrowing become severe. TAVR may be an option for people at intermediate to high risk of surgical complications.

Aortic stenosis is usually progressive. For some people, it never becomes severe or requires surgery. But in most cases, symptoms eventually develop. Once symptoms are severe, the survival rate is about 50% after two years without surgery. At five years, it drops to 20%. Successful surgery extends life and allows people to return to a healthy life. So don’t ignore your doctor’s advice. Seek reassurance from a second opinion if you have doubts.

Most people do very well after surgery for aortic stenosis. Anticoagulation with a blood thinner is necessary after surgery. Depending on the type of valve replacement, this may be temporary or lifelong. The likelihood of needing another replacement in the future will also depend on the type of valve. These are important things to discuss with your doctor before surgery.