All about aortic stenosis

Aortic stenosis is a heart disease characterized by a narrowing of the aortic valve, which makes it difficult to pump blood to the body, resulting in shortness of breath, chest pain and palpitations.

This disease is mainly caused by aging and its most severe form can lead to sudden death, however, when diagnosed early, it can be treated with the use of medications and, in severe cases, by surgery to replace the aortic valve. Find out what recovery looks like after heart surgery.

Aortic stenosis is a disease of the heart where the aortic valve is narrower than normal, making it difficult to pump blood from the heart to the body. This disease is mainly caused by aging and its most severe form can lead to sudden death, but when diagnosed in time it can be treated through surgery to replace the aortic valve.

Main symptoms

The symptoms of aortic stenosis arise mainly in the severe form of the disease and are usually:

• Feeling of shortness of breath when performing physical exercises; Tightness in the chest that worsens over the years; Chest pain that worsens when making efforts; Fainting, weakness or dizziness, especially when performing physical exercises; Heart palpitations.

The diagnosis of aortic stenosis is made through clinical examination with the cardiologist and complementary tests such as chest X-ray, echocardiogram or cardiac catheterization. These tests, in addition to identifying changes in the functioning of the heart, also indicate the cause and severity of aortic stenosis.

The treatment of aortic stenosis is done through surgery, in which the deficient valve is replaced by a new valve, which can be artificial or natural, when it is made from swine or bovine tissue. Replacing the valve will cause blood to be properly pumped from the heart to the rest of the body, and the symptoms of tiredness and pain will disappear. Without surgery, patients with severe aortic stenosis or who have symptoms survive an average of 2 years.

How the treatment is done

The treatment of aortic stenosis depends on the stage of the disease. When there are no symptoms, and the disease was discovered through tests, there is no need for specific treatment. However, after the appearance of symptoms, the only form of treatment is surgery to replace the aortic valve, where the defective valve is replaced by a new valve, normalizing blood distribution throughout the body. This surgery is mainly indicated for patients who have severe aortic stenosis, since the mortality rate is high. Here are the treatment options:

1. In people without symptoms

Treatment for people who do not have symptoms is not always done with surgery, and can be done with the use of medications and changes in lifestyle, such as avoiding competitive sports and professional activities that require intense physical effort. The drugs used in this phase can be:

• To prevent an infectious endocarditis; To treat diseases associated with aortic stenosis.

Patients who do not have symptoms that can be indicated for surgery if they have a very reduced valve, progressive reduction in cardiac function or increased changes in cardiac structure.

2. In people with symptoms

Initially, diuretics such as Furosemide can be taken to control symptoms, but the only effective treatment for people who have symptoms is surgery, as the drugs are no longer enough to control the disease. There are two procedures for the treatment of aortic stenosis, depending on the patient's state of health:

• Replacement of the valve for surgery: standard surgery procedure with open chest, so that the surgeon can reach the heart. The defective valve is removed and a new valve is placed. Replacement of the valve by catheter: known as TAVI or TAVR, in this procedure the defective valve is not removed and the new valve is implanted over the old one, from a catheter placed in the femoral artery, in the thigh, or from a cut done close to the heart.

Valve replacement by a catheter is usually performed in patients with greater disease severity and less ability to overcome open chest surgery.

Replacement valve types

There are two types of valve for replacement in open chest surgery:

• Mechanical valves: they are made of synthetic material and have greater durability. They are generally used in patients under 60 years of age, and after implantation, the person will have to take anticoagulant medications daily and do periodic blood tests for the rest of their lives. Biological valves: made from animal or human tissue, they last from 10 to 20 years, and are usually recommended for patients over 65 years old. In general, there is no need to take anticoagulants, unless the person has other problems that need this type of medicine.

The choice of valve is made between the doctor and the patient, and depends on the age, lifestyle and clinical condition of each one.

Risks and complications that can occur in surgery

The risks posed by aortic valve replacement surgery are:

• Hemorrhage; Infection; Formation of thrombi that can clog blood vessels causing, for example, stroke; Infarction; Defects in the new valve placed; Need for new operation; Death.

The risks depend on factors such as age, severity of heart failure and the presence of other diseases, such as atherosclerosis. In addition, the fact of being in a hospital environment also carries risks of complications, such as pneumonia and hospital infection. Understand what hospital infection is.

The catheter replacement procedure, in general, carries fewer risks than conventional surgery, but there is a greater chance of cerebral embolism, one of the causes of stroke.

What happens if you don't treat aortic stenosis

Untreated aortic stenosis can evolve with worsening cardiac function and symptoms of intense tiredness, pain, dizziness, fainting and sudden death. From the appearance of the first symptoms, life expectancy can be as little as 2 years, in some cases, so it is important to consult the cardiologist to verify the need for surgery and subsequent performance. See what recovery looks like after replacing the aortic valve.

Main causes

The main cause of aortic stenosis is age: over the years, the aortic valve undergoes changes in its structure, which is followed by calcium accumulation and improper functioning. In general, the onset of symptoms begins after age 65, but the person may not feel anything and may even pass away without knowing that they had aortic stenosis.

In younger people, the most common cause is rheumatic disease, where calcification of the aortic valve also occurs, and symptoms begin to appear around the age of 50. Other rarer causes are birth defects such as the bicuspid aortic valve, systemic lupus erythematosus, high cholesterol and rheumatoid disease. Understand what rheumatism is.