Aortic Stenosis

Signs and Symptoms

Aortic stenosis is rare in infancy, occurring in only about a third of 1 percent of births. Symptoms of the disease often don't appear until middle age or later, making it the second most common congenital disease among middle-age people. Aortic stenosis can be mild, moderate or critical.

Although some people with aortic stenosis dont experience symptoms, the most common symptoms include:

• Chest pain at rest
• Dizziness
• Fatigue
• Inability to exercise

Diagnosis

Because there may be no obvious symptoms of aortic stenosis, the first sign of the condition is often a heart murmur, an extra sound the doctor hears during a chest examination. To make a definite diagnosis of aortic stenosis, the following tests may be performed:

• Echocardiogram, a test that uses sound waves to create a moving picture of the heart.
• Electrocardiogram (ECG or EKG), a test that records the electrical activity of the heart.
• Exercise stress test to test the effect of exercise on the heart.

Treatment

Babies, children and young adults who have aortic stenosis can be treated surgically or with a catheter procedure that splits the deformed valve leaflets to enlarge the opening without replacing the valve. These procedures are successful only if the aortic valve is still thin enough to be manipulated.

Stenosis may return and eventually cause the valves to stiffen. Another surgery or catheter procedure may be required later in life to further repair or replace the valve.

The catheter procedure is called balloon valvoplasty. During this procedure, a catheter — a thin, flexible, plastic tube — is inserted into the heart via blood vessels in the leg. Catheters can be used to carry very small instruments or repair devices, such as a balloon, to the heart. A balloon at the tip of the catheter is inserted into the narrow opening in the valve and then inflated to stretch the valve opening and separate the valve leaflets.

This balloon procedure, which opens the blocked valve in most patients, is performed in our Cardiac Catheterization Laboratory. Occasionally, a patient's valve will leak after the balloon procedure and a surgical repair is necessary.

For adults with severe stenosis, treatment is more likely to include surgical replacement with either a manufactured valve or valve from another person. Another surgical repair involves removing obstructive tissue, which may be done with valve replacement.

Patients with aortic stenosis are given antibiotics to avoid heart infections during surgery or dental work. Medications may be used to control symptoms of aortic stenosis, such as high blood pressure or heart rhythm problems.