Page 10 - Valley Life & Health

10 SATURDAY, JULY 27, 2019 THE MORNING CALL
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ASK THE
SHAILENDRA SINGH, M.D. FACC OF EASTON HOSPITAL

WHATYOUNEEDTOKNOWABOUTAORTICVALVESTENOSIS

hat is the Aortic Valve? valve replacement include angina (chest pain),
The aortic valve is one of the four syncope (lost of consciousness), and heart
W heart valves that controls the flow of failure symptoms (including orthopnea, edema,
blood between the left ventricle (one of four heart and paroxysmal nocturnal dyspnea). Other
chambers) and the aorta. From the aorta, blood is associated symptoms may be: shortness of breath,
delivered to the entire body for delivery of oxygen lightheadedness, dizziness, fatigue, weakness and
and vital nutrients. As one can imagine, if the exercise intolerance. While patients might be
aortic valve is not functioning optimally, this could categorized asymptomatic due to lack of functional
interrupt the speed and amount of blood received impairment, a very high event rate can be expected
by the rest of body (brain, heart, organs, etc.). In with echocardiographic evidence of significant aortic
some people, as they age, the valve degenerates stenosis and warrants clinical follow up.
with calcification and thickening which leads to
rigidity and prevents the valve from opening to How is Aortic Valve Stenosis diagnosed?
a certain degree. Aortic Valve stenosis is when The physical examination can further
the valve area starts to narrow ,which puts more provide clues on the severity of the aortic
pressure on the heart and ultimately restricts blood stenosis and burden on the cardiovascular
from getting to the rest of the body. system. While the physical examination can
point the clinician toward aortic stenosis,
Why is this a problem? further evaluation with echocardiography is
Aortic valve disease constitutes a chronic, warranted. Transthoracic echocardiography
progressive disease over time. Age-related, or Photo courtesy of Easton Hospital (TTE) remains the gold standard for evaluating
degenerative valvular heart disease, represents Shailendra Singh, M.D. FACC Interventional aortic stenosis. Evaluation of LV wall thickness,
the most common etiology of aortic stenosis in Cardiologist Chief of Cardiology, Easton Hospital systolic function, and aortic valve morphology
the elderly population. Degenerative aortic valve can be assessed with two-dimensional
disease affects over 25% of all patients over the with age, with 1 in 8 people older than age imaging. Doppler echocardiography provides
age of 65. Most patients have only mild thickening of 75 showing moderate to severe AS, which hemodynamic measurement, severity of
and normal valve function, called aortic sclerosis. is associated with increased morbidity and valvular stenosis and regurgitation, and
However 2%-5% of these patients have significant mortality. This represents a significant health pulmonary pressures. Further testing with
AS with obstruction of blood flow out of the heart. care burden that is projected to increase as submaximal stress testing can be useful in
Mild fibro-calcific leaflet changes progress to the population progressively ages. evaluation if the patient is asymptomatic.
active bone formation on the aortic valve apparatus,
causing significant obstruction and limiting blood What are the risk factors for What are the treatment options?
flow out of the heart to the rest of the body. developing Aortic Valve Stenosis? Aortic stenosis has high morbidity and mortality
Increased calcification of the valve cusps causes Traditional cardiovascular risk factors after the occurrence of symptoms, where the two-
increased valvular stiffness and narrowing. Over such as age, male gender, smoking, elevated year mortality risk is higher than 50%. Aortic valve
time, an increased aortic gradient causes a pressure LDL cholesterol, hypertension, and metabolic replacement with either open-heart surgery or
overload, resulting in heart chamber wall thickening syndrome have been associated with development Transcatheter aortic valve replacement (TAVR) are
and hypertrophy. After a continued cascade of and progression of aortic stenosis. Elderly patients the only treatment modalities that reduce morbidity
events, this may eventually lead to cardiac failure if with aortic stenosis typically have concomitant and mortality with significant aortic stenosis. Prior
not treated appropriately. coronary or peripheral vascular disease. Risk to the advent of TAVR, over one third or more
factors associated with disease initiation may differ of patients were unsuitable to undergo valve
Who is affected and how often from those that promote disease progression; replacement due to age-related comorbidities.
does it occur? regardless, the disease progresses more rapidly at TAVR has emerged as an alternative in those who
As the population continues to age, aortic elderly age. Treatment with medications such as cannot undergo surgery or who are intermediate
valve stenosis (AS) remains the most prevalent beta-blockers, statins, or bisphosphonates studied and high risk for surgical valve replacement.
valvular heart disease in western countries and in randomized trials have not proven to be of Despite the significant comorbidities of the elderly,
is the most frequent cause of sudden death benefit in reducing or halting progression of AS. the outcomes for aortic valve replacement have
among valvular heart diseases. Due to advances been improving. Randomized trials have shown no
in health care the population has a longer life What are the symptoms significant differences in mortality between surgical
span and thus there is an increase in surveillance of Aortic Valve Stenosis? valve replacement (SAVR) vs. TAVR in patients
and diagnosis of AS. While incidence is low in In evaluating elderly patients with aortic who are intermediate and high risk. Recent studies
patients less than 60 years of age, it increases stenosis, it is important to elicit a comprehensive of TAVR in the elderly have shown an acceptable
to approximately 10% in patients 80 years and meticulous history. The three cardinal short and long-term survival benefit along with
old and greater. The severity of AS increases symptoms of aortic stenosis that prompt urgent improvements in function and quality of life.