Aortic Stenosis

Aortic stenosis (AS) is a degenerative disease of the heart valve caused by thickening, stiffening and calcification of the aortic valve leaflets, restricting the valve orifice and impairing the ejection of blood from the left ventricle into the aorta during systole. The condition causes the heart to work harder, resulting in left ventricular hypertrophy and eventual heart failure if not treated. Most commonly seen in older persons due to age-related calcification but can also be caused by congenital bicuspid valves and rheumatic fever.

The diagram displays the flow impeded by the stenotic valve in relation to normal anatomy.

Symptoms & Diagnosis

Early AS may be asymptomatic, but as it progresses, patients develop exertional dyspnoea, angina, syncope, and palpitations. Poor eating or failure to thrive in infants. The diagnosis is done by echocardiography to examine the valve area, gradients, and function, commonly with ECG or cardiac catheterisation.

Treatment Choices

Mild cases are managed with drugs (diuretics or beta-blockers) to relieve symptoms. Severe symptomatic AS is an indication for intervention, either surgical aortic valve replacement (SAVR) or minimally invasive transcatheter aortic valve replacement (TAVR). TAVR is appropriate for high-risk individuals with rapid recovery. It is important to monitor to avoid sudden death problems.