Aortic Stenosis

Aortic stenosis is a heart valve condition in which the aortic valve narrows, limiting blood flow from the heart to the rest of the body. The narrowing forces the heart to work harder, which can eventually weaken it. Without treatment, severe aortic stenosis can lead to heart failure and other serious complications.

Aortic stenosis is typically classified by its underlying cause:

• Congenital Aortic Stenosis – Present at birth; may involve a bicuspid aortic valve (having two valve leaflets instead of three).
• Degenerative (Calcific) Aortic Stenosis – Most common in older adults due to age-related calcium buildup and thickening of the valve.
• Rheumatic Aortic Stenosis – A complication of rheumatic fever, an inflammatory condition that can develop after a streptococcus infection, leading to scarring and narrowing of the aortic valve over time.

The severity of aortic stenosis is classified as mild, moderate, or severe.

Aortic stenosis can develop for several reasons:

• Older Age-Related Degeneration – Calcium deposits cause the valve to stiffen, most common in older adults
• Congenital Valve Abnormalities – Like a bicuspid valve.
• Rheumatic Heart Disease – Rare in the U.S. but remains a leading cause worldwide, particularly in developing countries.
• Radiation therapy to the chest
• High blood pressure
• High Cholesterol
• Diabetes Mellitus
• Obesity
• Smoking
• Chronic Kidney Disease

Mild or moderate aortic stenosis may cause no symptoms. As the condition worsens, symptoms may develop gradually or suddenly and often indicate a need for intervention:

• Chest pain or pressure, especially during physical activity
• Shortness of breath, especially during activity
• Fatigue
• Dizziness or fainting, especially during activity
• Heart palpitations

These symptoms may worsen over time, especially if left untreated.

If symptoms suggest aortic stenosis, early evaluation is essential. Diagnosis usually begins with a physical exam and listening for a heart murmur using stethoscope. Common diagnostic tests include:

• Echocardiogram – Primary tool for evaluating valve function. It uses ultrasound to evaluate valve structure, blood flow, and severity of stenosis.
• Electrocardiogram (EKG) – Detects abnormal electrical heart activity.
• Cardiac MRI or CT – Used for detailed assessment of valve anatomy, calcium burden, and pre-procedural planning.
• Cardiac Catheterization –Occasionally used to directly measure pressure across the valve, especially if echocardiogram results are unclear.

Treatment depends on the severity of stenosis and presence of symptoms. While mild cases may be monitored, moderate to severe aortic stenosis, especially when symptoms are present, often requires intervention.

• Monitoring (Watchful Waiting) – For mild or moderate AS, regular echocardiograms and clinical follow-up may be recommended.
• Medication – While no medications can reverse valve narrowing, they may help manage associated symptoms like high blood pressure or fluid buildup.
• Surgical Aortic Valve Replacement (SAVR) – Traditional open-heart surgery to replace the diseased valve with a mechanical or tissue valve.
• Transcatheter Aortic Valve Replacement (TAVR) – A minimally invasive procedure in which the diseased aortic valve is replaced using a catheter inserted through a small incision, typically in the femoral artery. TAVR is an effective alternative to open-heart surgery for select patients, including those who are high-risk, elderly, or not candidates for traditional surgical valve replacement.
• Balloon Valvuloplasty – A procedure that uses a balloon-tipped catheter to temporarily widen the narrowed aortic valve. This is a temporary solution mainly used in children or young adults or as a bridge to valve replacement in adults who are not ready for definitive intervention.

At Baptist Health, our team includes specialists skilled in both surgical and transcatheter valve procedures, ensuring you receive the most appropriate and advanced treatment available.

If untreated, aortic stenosis can lead to serious complications:

• Heart Failure – The heart weakens over time.
• Arrhythmias – Irregular heart rhythms.
• Stroke – Due to blood clots or poor circulation.
• Endocarditis – An infection of the heart valve
• Sudden Cardiac Death – In rare cases.

While aortic stenosis can’t always be prevented, especially in congenital or age-related cases, certain steps may help reduce risk or slow progression:

• Control blood pressure and cholesterol through diet, exercise, and medications
• Quit smoking
• Stay physically active and maintain a healthy weight
• Prevent rheumatic fever with early treatment of strep infections with antibiotics
• Monitor congenital heart conditions
• Get regular heart checkups, especially if you have risk factors or a family history of valve disease