Ask A Doctor - Aortic valve stenosis - DesiMD Healthcare Services


What is Aortic valve stenosis? my mother aged 49 was told that hrr left valve is narrow and hence declared moderate Aortic valve stenosis? is that serious? does this need any surgery? - Asked by c k on 24-Jan-2014 18:51:38

Answer Count: 4    Disorder Type: Cardiac disorders

  • Internal Medicine

    Answered by Dr. Suneel Vallabhaneni on 24-Jan-2014 19:37:02

    • Aortic valve is the valve between left ventricle (one of the four chambers of heart) and aorta (the great vessel that carries blood from the heart to the rest of the body). This valve is one of the four valves in the heart.
    • Surgery is clearly indicated, if the stenosis is
      • Severe (valve area < 1 cm2) with either of these 3 symptoms
        • Chest pain
        • Shortness of breath
        • Loss of consciousness for seconds to minutes (syncope)
    • Please talk to a cardiologist for other indications for surgery and to know more about the valve area for your mother.

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  • Internal Medicine

    Answered by Dr. Suneel Vallabhaneni on 25-Jan-2014 04:18:37

    • Looks like my answer got interrupted.
    • Here is the missed part - if the valve area is < 1 cm2 with either of these symptoms - shortness of breath (manifestation of heart failure) or chest pain/ angina or loss of consciousness/ syncope - on exertion.
    • You can talk to your heart doctor to know the valve size and follow his advice. Also educate your mother to watch for the above symptoms. 

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  • MBBS, MD
    Internal Medicine
    Languages Known: English, Telugu

    Answered by Dr. Satish Potluri on 25-Jan-2014 04:36:27

    Dear CK,

    Nice question. Hope your mom is feeling ok.

    To answer this,

    • We need to know why she had the ultrasound of heart (echocardiogram ) done in first place.
      • Check out the anatomy of heart pictorially described in DesiMD article
      • The door between the left lower chamber of heart and the blood vessel (aorta) that carries blood to other parts of the body is called the aortic valve. When the door doesn't open properly, we call it as stenosis (narrowing)
      • Normal Aortic valve is between 3.0-4.0 square centimeter.
      • There are other modalities to see
        • Severity (medical jargon like mean gradient and jet velocity which we will not touch now)
        • Symptoms to be concern in aortic stenosis:
          • A) angina (like intermittent chest pain)
          • B) syncope ( like dizziness leading to fall and loss of consciousness)
          • C) Heart failure
        • These symptoms occur mostly after exertion (like movement, walking uphill, steps, running etc)
        • Studies show that most people survive only 2-3 years after these symptoms and can die if no intervention done
      • People can have a prolonged symptomatic phase with Aortic stenosis till these symptoms develop
      • Severity of Aortic stenosis based on valve area ( all in square centimeters)
        • Mild. : > 1.5
        • Moderate : 1.0 - 1.5
        • Severe. : < 1.0
        • Critical. : < 0.75 Verse severe : < 0.6
    • Let's talk about treatment Medical
      • Only if your mom doesn't have symptomatic severe aortic stenosis / critical stenosis / very severe stenosis, treat high blood pressure. Medications like
        • Lisinopril will help
        • Cholesterol reducing drugs like statins help overall heart function but studies doesn't show prevention of progression of stenosis
      • Echocardiogram: Check ultrasound of heart (echocardiogram ) every 3-5 years
        • In mild Aortic stenosis 1-2 years
        • In moderate AS (aortic stenosis) 1 year
        • In severe stenosis, if not symptomatic, surgical management, which is of 2 types
          • Surgical replacement of aortic valve
          • Transcather aortic valve replacement
      • Keep in mind that after symptoms start overall mortality (like death) rate is more than 90 %
      • Indications of surgery:
      1. Aortic stenosis with symptoms like chest pain, dizziness and loss of consciousness or heart failure
      2. Severe Aortic stenosis with repair of other valves ( there are tricuspid, mitral and pulmonary valves - total 4 kinds including aortic valve), coronary bypass surgery called as CABG
        • Severe Aortic stenosis associated with decreased pumping capacity of heart (< 50%), Aortic valve replacement is favored
      3. In Moderate aortic valve stenosis associated with repair of aorta ( major blood vessel), bypass surgery (CABG) or as said before if surgery of other valves is needed.
    • Meanwhile, keep a good dental hygiene ( teeth cleaning and maintaining healthy teeth) to prevent bacterial infection spreading from teeth to aortic valves ( technical term infective endocarditis)

    Hope this helps Best wishes

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  • MBBS, MD
    Cardiovascular Diseases
    Languages Known: English, Telugu

    Answered by Dr. Ajay Tripuraneni on 25-Jan-2014 21:17:31

    Dear CK:

    • Aortic valve is a like door between the left lower chamber of the heart called left ventricle and the big blood vessel called aorta, that sends purified blood to the whole body. When the heart squeezes blood the three parts of the aortic valve open, and when the heart is filling up with blood they remained closed.
    • I have reviewed the reports you have sent us. In your mom's case there are only two parts of the valve based on the report, as a result calcium tends to build up sooner than later. This causes narrowing of the valve..
    • Her blood counts are within normal limits. Her blood sugars are close to high normal, so would pay attention by yearly check.
    • EKG has some non specific changes that could be related to heart muscle thickening from the narrowed valve. The stress test is positive with EKG changes, did she have any symptoms during the treadmill test?
    • Would suggest:
      • Consideration of an angiogram especially if she had symptoms during the stress test
      • IF the angiogram is ok, would recommend annual ultrasound of the heart, and when the valve is severely narrowed would recommend replacement with an artificial valve.
      • Valve replacement is recommended sooner, if she has chest pain with activity, trouble breathing and leg swelling or passing out spells.
      • If the angiogram is positive, then we need to re-evaluate the next steps. This all based on the echo report you have sent us (and not the images)

    The above is for information use only, please consult your local cardiologist for a comprehensive treatment plan.

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