Last updated on January 5, 2022
Content By: Dr. Nikita Toshi BDS, Assistant Manager (Medical Review), Dr. Ritu Budania MBBS, MD (Pharmacology) Head, Medical Affairs &
Last updated on January 5, 2022
The aortic valve is a part of the heart that keeps the blood flowing in the right direction in the body. It is located between the heart’s main pumping chamber, the left ventricle and the artery that supplies oxygen-rich blood to the rest of the body, the aorta. When the ventricle contracts, the aortic valve opens up and allows the blood to flow into the aorta. When the ventricle relaxes, the aortic valve closes and prevents the blood from flowing back into the ventricle. The aortic valve has three cusps, which are like flaps, which open and close in order to regulate the blood flow. Aortic stenosis causes the aortic valve of the heart to become narrow. As the valve can’t reopen fully, it blocks blood flow from the heart to other parts of the body. Aortic stenosis treatment is necessary for reducing the health risks such as heart failure associated with the condition. Read this comprehensive guide to learn more about the condition, including its risk factors, diagnosis methods and options for cure.
The aortic valve is a part of the heart that keeps the blood flowing in the right direction in the body. It is located between the heart’s main pumping chamber, the left ventricle and the artery that supplies oxygen-rich blood to the rest of the body, the aorta. When the ventricle contracts, the aortic valve opens up and allows the blood to flow into the aorta. When the ventricle relaxes, the aortic valve closes and prevents the blood from flowing back into the ventricle. The aortic valve has three cusps, which are like flaps, which open and close in order to regulate the blood flow. Aortic stenosis causes the aortic valve of the heart to become narrow. As the valve can’t reopen fully, it blocks blood flow from the heart to other parts of the body. Aortic stenosis treatment is necessary for reducing the health risks such as heart failure associated with the condition. Read this comprehensive guide to learn more about the condition, including its risk factors, diagnosis methods and options for cure.
Written by
BDS, Assistant Manager (Medical Review)
Reviewed by
MBBS, MD (Pharmacology) Head, Medical Affairs
Aortic valve stenosis happens when the aortic valve of the heart becomes deformed or thick leading to the narrowing of the opening of the aorta. The treatment of aortic stenosis depends on the severity of the condition. Some people might need surgery to replace or repair the aortic valve. Some patients might have a unicuspid valve. A person with a unicuspid valve has just one cusp (triangular segments of the valve which open and close with the flow of blood) instead of three and some might need a bicuspid valve (where instead of three cusps, the person has just two). Without proper treatment, aortic valve stenosis can be fatal.
The prevalence of aortic stenosis is around 46 per 100,000 people in northern India. The condition is usually common in older adults. However, sometimes the condition can be witnessed in infants. Men are more at risk of this condition than women.
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An integral part of understanding any condition involves becoming more aware of how the condition is caused and identifying factors that can increase the risk of developing the condition. Here are some causes and risk factors of aortic stenosis that you should be aware of, so you can watch out for them and be better prepared if you have the risk factors:
Calcium Deposits: Calcium is present in the blood. Due to the repeated flowing of blood over the aortic valve in the heart, calcium gets deposited on it. The calcium deposits usually do not cause any problems. Even if a calcified aortic valve causes symptoms, they do not show up till 70 to 80 years. But in some cases, the calcium deposits start stiffening the valve cusps (triangular segments of the valve which open and close with the flow of blood) at a young age. You need to know that the calcium deposits in the aortic valve in the heart are not related to consuming calcium tablets or food items containing calcium.
Congenital heart defects: Sometimes, children are born with aortic valves containing two cusps instead of three. Sometimes there can be a presence of one or four cusps. This abnormality in the number of cusps in the aortic valve calls the need for regular medical checkups. The valve usually does not cause any problems until adulthood. But if the valve becomes narrow or begins to leak, it has to be replaced or repaired. Therefore, you might need bicuspid valve treatment or unicuspid valve treatment, depending on the number of valves you have.
Rheumatic fever: Rheumatic fever is a condition that causes inflammation and pain in the joints. It usually develops when a strep throat infection is left untreated or is not treated completely. Rheumatic fever can lead to scar tissue forming on the aortic valve. Scar tissue can narrow the opening of the aortic valve. It might also create a rough surface where calcium gets deposited, resulting in a calcified aortic valve. Rheumatic fever can lead to the damage of more than one heart valve and in several ways.
Take a look at the risk factors that can lead to the development of aortic valve stenosis:
Old age
Congenital heart disease
History of heart infections
Radiation therapy to the chest
Chronic kidney disorders
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It is extremely important to understand the symptoms of the condition. It can help in early detection, which in turn, can facilitate more effective treatment and improve the outlook. Here are a few of the signs and symptoms of aortic stenosis that you should watch out for.
Fatigue upon exertion: Having aortic stenosis means infants will feel fatigued upon the slightest bit of exertion.
Failure to gain weight: Infants with cardiac stenosis have trouble gaining weight. They often show symptoms of constricted growth due to this issue.
Poor feeding: Infants with aortic stenosis show signs of poor feeding. They often get too exhausted while feeding. Most of the time, tube feeding replaces bottle feeding in infants with aortic stenosis.
Breathing problems: Aortic stenosis is associated with breathing problems in infants. If your infant is showing signs of shallow, laboured or rapid breathing, seek medical attention. Doctors look for signs of aortic stenosis murmur if babies face breathing difficulties.
Chest pain: Aortic stenosis treatment is often begun after noticing immense chest pain in individuals.
Rapid or fluttering heartbeat: Patients with this condition often experience aortic stenosis murmur. It is associated with irregular heartbeats and abnormal heart sounds.
Difficulty breathing: Having aortic stenosis means an individual will face trouble while breathing. An individual with this condition may face breathing difficulties while doing strenuous activities. Breathing trouble might also show up while resting.
Feeling dizzy or light-headedness: Sudden feelings of dizziness or light-headedness are not given much attention. But it can be a sign of serious conditions like aortic stenosis.
Swollen ankles or feet: A swollen feeling in the ankles or feet is indicative of aortic stenosis. Due to inadequate circulation of blood throughout the body, ankles and feet in particular often become swollen.
A decline in activity level: Poor blood circulation in the body is associated with decreased levels of energy. As the heart tries to work faster than usual, constant fatigue and tiredness might be experienced.
Difficulty in sleeping or need to sleep while sitting upright: People with aortic stenosis often complain about sleeping difficulties. They might feel the need to sit up in the middle of sleeping because of discomfort in the body.
Most patients with aortic stenosis remain asymptomatic for quite a long time. As the problem worsens or the age of the individual increases, the symptoms start showing up gradually. Dyspnea or shortness of breath is one of the primary symptoms of aortic stenosis in 50% of the patients. Syncope or temporary loss of consciousness due to a fall in blood pressure is noticeable in 35% of patients with aortic stenosis. Angina or left side chest pain is experienced by around 15% of the patients suffering from this condition.
If you experience any of the symptoms of aortic stenosis, you should go and visit a cardiologist. The cardiologist will recommend you a suitable treatment option. An infant exhibiting any of the symptoms mentioned above should be taken to a paediatric cardiologist.
It is not always necessary that experiencing these symptoms mean that you have aortic stenosis. The symptoms can suggest other cardiovascular diseases as well. For instance, breathing difficulties are associated with pulmonary hypertension, angina and other conditions affecting the heart.
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If you or your child experience any of the signs and symptoms of aortic stenosis, you must consult your doctor without any delay. Your doctor will then suggest you to take certain diagnostic tests based on the severity of your symptoms. Mentioned below are a few of the possible tests you might be asked to undergo for aortic stenosis diagnosis:
Auscultation: It is the medical term for listening to the heart sounds of an individual with a stethoscope. It helps in understanding the early signs if a person is suffering from any type of heart disease. The doctor puts a stethoscope on your chest and listens for irregular heartbeats or arrhythmia.
Electrocardiogram (ECG): It is a painless test used to detect the electrical activity of the heart. Small sensors called electrodes are attached to the chest, arms and sometimes even legs to monitor the functioning of the heart.
Chest X-ray: It is often done if a doctor suspects you need treatment for aortic stenosis. The test can show swelling of the arteries or calcium deposits and condition of lungs.
CT scan: Sometimes CT scan of the chest is done to obtain a cross-sectional view of the heart. It can help in measuring the size of the aorta. It is also possible to get a closer look at the aortic valve.
Echocardiogram: In an echocardiogram, sound waves are used to create images of the heart. It helps in showing how blood flows through the heart and heart valves. It also helps in determining if the heart muscle is weak. The severity of the condition is often measured through this test before beginning treatment for aortic stenosis.
Cardiac MRI: This test helps in detecting the severity of aortic stenosis using magnetic fields and radio waves. The test can also aid in evaluating the size of the aorta.
Cardiac catheterization: This test is used if other tests are unable to detect the prevalence of aortic stenosis, but your doctor still suspects you have it. The test helps in measuring the amount of blood pressure in the chambers of the heart. A thin tube is inserted through a blood vessel in the arms or groin to the arteries in the heart.
If you think you need aortic stenosis treatment, you have to find a good cardiologist. You can remember these tips while going for your appointment with a cardiologist.
Note down your symptoms: Before visiting the doctor, you can write down the symptoms you are experiencing. Noting down the symptoms helps in ensuring that you don’t miss out on telling any of the symptoms.
Make a list of medications you take: It is always a good idea to make a list of medications you take before visiting a cardiologist. It will help the doctor understand if any of the side effects you are experiencing is due to the medications.
Write down medical history: You need to write down your medical history for the doctor to refer to. It might also be beneficial to write about the prevalence of heart diseases in your family.
Ask someone to accompany you: Lastly, ask someone to accompany you to the diagnostic centre. Taking a friend or family member with you can boost your confidence and put you at ease.
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If aortic stenosis is left untreated for long, it could lead to an increased risk of developing other health conditions. Here are a few of the complications of aortic stenosis you should know about, so you could be better equipped to deal with them:
Heart failure: Due to a lack of blood flow to the other organs, the heart works faster than usual. Excessive pressure on the heart can result in heart failure.
Blood clots: As blood cannot flow effectively through the body, it might clot in certain places. Blood clots can be fatal if they are formed in the heart or the brain.
Stroke: The narrowing of the aortic valve can sometimes restrict the adequate flow of blood to the brain. It increases the risk of strokes in patients suffering from this condition.
Arrhythmia: This condition is associated with the abnormal beating of the heart. The heart might beat too fast or too slow due to the added pressure on it to pump blood.
Endocarditis: This is a type of infection that leads to inflammation of the endocardium. The endocardium is the soft tissue with which the lining of the chambers and valves of the heart is made of. It is the innermost layer of the heart’s walls and is the barrier between the heart muscles and the bloodstream. Infections in other parts of the body travel to damaged parts of the heart through the bloodstream and cause this infection.
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If you or your child is diagnosed with aortic stenosis, the doctor will suggest the most appropriate treatment option to avoid further complications or prescribe certain medications to help manage the symptoms. Here are a few of the non-surgical and surgical procedures for aortic stenosis available in India.
Observation & Care: Going to regular medical checkups can lead to the detection of aortic stenosis in a person before they start showing symptoms. Early detection is useful in providing the best treatment for aortic stenosis.
Medication: Aortic valve stenosis treatment without surgery is not possible. But some medications can help in managing the symptoms.
Valvuloplasty: A long and thin tube is inserted into an artery in the arm or groin. The tube is made to reach the aortic valve. After it reaches the destination, the balloon is inflated to open the narrow arteries. This procedure is mostly used in infants and children. There can be a need for another procedure after the child grows up.
Aortic Valve Replacement: In this surgery, the aortic valve is replaced with a mechanical valve. These valves need to be replaced after a certain period. People undergoing this surgery need to take blood-thinning medications throughout their lives.
TAVI/TAVR: It is a less invasive method to manage aortic stenosis. This is executed in patients who are at high risk of complications due to surgical removal of the aortic valve.
Transcatheter Aortic Valve Replacement (TAVR) involves the replacement of the aortic valve by inserting a catheter from the patient’s chest or leg region.
Some of the best hospitals in India for aortic valve replacement are as follows:
Fortis Escorts Heart Institute, New Delhi
Apollo Hospital, Chennai
Medanta- The Medicity, Gurgaon
Kokilaben Dhirubhai Ambani Hospital, Mumbai
Indraprastha Apollo Hospital, New Delhi
The cost of aortic valve replacement in India depends on the hospital where you get it done. But the average cost of valve replacement surgery in India can range from two to five lakhs. The cost of aortic stenosis treatment in India will be worth the quality of care you receive.
Potential complications you may have: After undergoing an aortic valve replacement surgery, you might be facing complications like bleeding and infection. Blood clots can also form in the body after you undergo valve replacement surgery. You will also be at high risk of a stroke after aortic valve replacement surgery.
Follow up care: Do not forget to undergo regular medical checkups after such a massive surgery. You have to follow all the instructions of the doctor to avoid postoperative complications. You might be restricted from engaging in some physical activities after this surgery.
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It is possible to prevent aortic stenosis if you take extra efforts to better manage the risk factors of the condition, maintain good hygiene and adopt a few lifestyle changes. Read on to find the preventive measures you must take to help avoid aortic stenosis. Patients with aortic stenosis who have been cured should also follow these measures to avoid a relapse:
Having a healthy pregnancy: If you are a woman with aortic stenosis, consult a doctor before conceiving. You might need to undergo a valve procedure before getting pregnant.
Controlling the risk factors of coronary artery disease: It is important to be able to control the risk factors associated with coronary artery diseases. It includes high cholesterol and high blood pressure.
Taking steps to prevent rheumatic fever: To prevent this, visit a doctor whenever you have a sore throat. Antibiotics will be prescribed to help you recover. Otherwise, it might put you at risk of getting rheumatic fever, especially when you are a child.
Diet and activity restrictions (limiting certain exercises): It is also essential to follow a heart-healthy diet. Engage in at least thirty minutes of physical activities every day. It might include brisk walks or yoga.
Maintain a healthy weight: It is essential for patients with aortic stenosis to maintain a healthy weight. Being overweight puts pressure on your heart.
Manage stress: Physical, as well as emotional stress, can trigger an aortic stenosis relapse. You have to figure out ways like mediation and art therapy to reduce your stress.
Preventing gingivitis, maintaining good oral hygiene to prevent cardiac infections: Sometimes, there is a link between gingivitis (A common, mild disease of the gums) and endocarditis. Inflammation of the heart tissue causes arteries to narrow down. Therefore, it is important to take care of your oral health.
Quit smoking: If you had aortic stenosis surgery in the past, smoking could be extremely risky for you.
As discussed earlier, most of the time, people with this condition do not exhibit any symptoms. For these patients, the outlook is generally good and they can live healthily for years if they treat the condition properly. For people with mild to moderate aortic stenosis, surgery is required to replace or remove the aortic valve and manage the condition. The outlook for these patients is great too and they can also survive for many years with the proper treatment. Severe aortic stenosis, however, can be dangerous and potentially fatal and needs to be treated immediately. Aortic Stenosis can also be quite dangerous in older people, as there are various other complications that can arise and these older people might not be suitable candidates to receive surgery. You should talk to your healthcare provider about the right treatment options and outlook.
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While mild aortic stenosis might not be deadly, severe aortic stenosis can be life-threatening. Once patients with severe aortic stenosis begin showing symptoms, it should be brought under immediate medical attention. In case of severe aortic stenosis, Immediate surgery is required or else it might lead to a low survival rate in patients.
TAVR stands for transcatheter aortic valve replacement and TAVI stands for transcatheter aortic valve implantation. Both the procedures are executed in a similar manner. Medical practitioners often use the terms interchangeably. Curing the aortic valve with a transcatheter is not required in case of mild aortic stenosis.
Sometimes medications are given to manage aortic stenosis symptoms. Some lifestyle changes can also help in preventing the risk of aortic stenosis. But medications and lifestyle changes cannot help in reversing aortic stenosis. The only effective cure for this condition is by repairing or replacing the diseased aortic valve. Usually, the diseased aortic valve is replaced through open surgery. However, aortic valve stenosis treatment without surgery is possible with less invasive methods like transcatheter aortic valve replacement.
Aortic stenosis without treatment can be life-threatening. Patients who start exhibiting symptoms of aortic stenosis have a survival rate of 50% at two years. At five years without aortic valve replacement surgery, the survival rate is around 20%.
Most aortic stenosis patients with severe symptoms die within 2-3 years of being diagnosed with the condition. But if the condition is diagnosed and treated early, people can live long and rewarding lives. It is important to go for regular medical checkups when diagnosed with aortic stenosis. Going for regular checkups can help in the diagnosis of aortic stenosis even before exhibiting symptoms.
The long term effects of unrepaired aortic stenosis include the following:
You should seek immediate medical attention after experiencing symptoms associated with aortic stenosis. You should ask your doctor the reason behind experiencing symptoms related to cardiac stenosis. It is also important to know about diagnostic tests and treatment methods from the doctor.
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