Aortic Stenosis: A Narrowed Valve, A Bigger Risk

Aortic stenosis is a common type of heart valve disease that affects how blood flows from the heart to the rest of the body. Without treatment, it can lead to serious complications. Today, minimally invasive valve replacement procedures, especially for older adults, offer more options and a faster recovery.

What Is Aortic Stenosis?

Aortic stenosis occurs when the aortic valve in your heart narrows and no longer opens fully. This blocks blood flow into the aorta and puts added pressure and strain on the heart.

“Aortic stenosis is a fairly common condition where the aortic valve does not open properly,” said Saeed Shaikh, MD, an interventional cardiologist at Franciscan Health in Indianapolis and Lafayette. “It’s a big burden on the population, particularly those 65 years and older.”

Age-related calcium buildup causes most cases, but a congenital heart defect or rheumatic fever can also lead to the disease.

Read more about heart valve disease.

What Are The Symptoms Of Aortic Stenosis?

Aortic stenosis often develops slowly, which makes early detection difficult. In many cases, people do not experience symptoms of aortic stenosis until the narrowing of the valve becomes more severe. When symptoms do appear, they may affect daily activities and overall quality of life.

Common signs of aortic stenosis include:

• Chest pain or tightness, especially with activity
• Dizziness or fainting
• Feeling tired or weak
• Irregular heartbeat or palpitations
• Shortness of breath
• Swollen ankles or feet

“If you notice shortness of breath during your daily activities or you faint, those are signs to take seriously,” said Dr. Shaikh.

Because symptoms may seem minor or mimic other health conditions, regular checkups with a healthcare provider can help detect problems early, especially for older adults or those at a higher risk for the disease.

“Aortic stenosis often goes unnoticed,” Dr. Shaikh said. “Many people never realize they have it until a doctor hears something unusual with a stethoscope.”

Who Is At Risk For Aortic Stenosis?

Anyone can develop aortic stenosis, but certain factors increase your risk. It is more common in:

• People over age 65
• Individuals born with a bicuspid aortic valve (only two leaflets instead of three)
• Those with a history of heart valve problems
• People with a history of rheumatic fever
• Those with chronic kidney disease or past chest radiation

Men and women both develop aortic stenosis, but age remains the leading risk factor.

How Do Doctors Diagnose Aortic Stenosis?

Doctors diagnose aortic stenosis by first reviewing your symptoms and medical history. They will listen to your heart for a murmur, a key clue that leads to further testing.

Doctors may order tests such as:

• Echocardiogram (ultrasound of the heart)
• Electrocardiogram (ECG)to assess electrical activity
• Chest X-ray
• Cardiac catheterization for a closer look at blood flow

An echocardiogram is the most accurate tool for diagnosing aortic stenosis and is used to help track it over time.

Can You Prevent Aortic Stenosis?

While some causes are out of your control, you can lower your risk of aortic stenosis by taking care of your heart health. That means:

• Avoid smoking
• Manage high blood pressure and cholesterol
• Stay active
• Control blood sugar if diabetic
• See your doctor for regular checkups

How Is Aortic Stenosis Treated?

Aortic stenosis treatment depends on the severity of the valve narrowing. Mild cases of aortic stenosis may only need regular monitoring. More serious cases require valve replacement.

For years, treatment relied on surgical aortic valve replacement. This open-heart procedure involved greater risk and a longer recovery.

“In the past, many patients could not tolerate open surgery due to age or other health conditions,” said J. Michael Tuchek, DO, a cardiothoracic surgeon at Franciscan Health Crown Point and professor of cardiothoracic and vascular surgery at Loyola University Medical Center.

Everything changed in 2014 when the FDA approved a new, less invasive option, Transcatheter Aortic Valve Replacement (TAVR). This approach allows physicians to insert a new valve through a small opening in the femoral artery in the groin, which eliminates the need to open the chest.

“The technology was truly disruptive,” said Dr. Tuchek. “It changed everything overnight.”

TAVR received expanded approval in 2019 and now helps a wider range of patients, including those once considered too high-risk for surgery. Dr. Tuchek performed one of the first TAVR procedures in Illinois during its clinical trial phase.

“TAVR gave us a less invasive way to take care of an aortic valve problem where surgery had been the only option,” he said. “It has changed the landscape for many patients.”

Franciscan Health uses the Sentinel Cerebral Protection System during the procedure to help prevent stroke, a rare but serious risk.

“One of the biggest complications of aortic valve replacement — whether surgical or transcatheter — was the risk of disabling stroke,” Dr. Shaikh said. “We use the special (cerebral embolic protection) device to reduce the risk of disabling stroke for our patients, which positions us at the cutting edge for this technology.”

What Happens If You Don’t Treat Aortic Stenosis?

Without treatment, severe aortic stenosis can lead to:

• Dangerous irregular heart rhythms
• Heart failure
• Sudden cardiac death

“Twenty years ago, as many as 60 to 80 percent of patients with aortic stenosis were not in treatment. They were too sick or too old to tolerate open surgery,” Dr. Tuchek said. “TAVR gave us a less invasive way to take care of an aortic valve problem where surgery had been the only option.”

TAVR also strengthens collaboration between specialists. At Franciscan, cardiologists and heart surgeons work together to personalize care for each patient.

“TAVR has changed the way we practice medicine,” Dr. Tuchek said. “We’ve learned that when we work together, we provide the best outcomes for our patients.”

When Should You Seek Help?

If you feel faint, short of breath or experience chest pain, especially when being active, contact your healthcare provider. These symptoms may seem minor at first, but they can signal serious heart valve problems.

Franciscan Health offers minimally invasive valve replacement options like TAVR, along with expert heart care across Indiana and Illinois.

Call (877) 285-6180 or request an appointment today.