At Lankenau Medical Center, our goal is to make sure that each patient
with aortic valve disease receives the most effective treatment possible
for his or her condition. Our Valve Clinic specialists offer expertise
in medical, surgical, and transcatheter (TAVR) treatment of aortic
stenosis. After a thorough evaluation, and in collaboration with a
patient’s referring doctor, an individualized plan of care will be
presented that best supports a patient’s needs and offers the
Aortic stenosis is a disorder of the aortic valve, one of the four
valves that regulate blood flow through the chambers of the heart. All
heart valves work to make sure that blood flows in one direction only.
The aortic valve controls the flow of blood from the heart to the main
artery that supplies the body.
normal healthy aortic valve has three flaps of tissue (called leaflets)
that open wide to allow blood to pump freely from the heart and then
close completely to prevent blood from leaking backward. In aortic
stenosis, the valve leaflets are stiff and cannot open fully, limiting
the flow of blood to the body.
Aortic stenosis can be caused by a birth defect, rheumatic fever,
radiation therapy, medication, or inflammation in the heart. The most
common cause is a buildup of calcium (mineral deposits) on the valve’s
leaflets. This is called calcific aortic stenosis—a condition
that mainly affects people aged 75 or older.
Symptoms and Complications
Aortic stenosis usually progresses slowly and worsens over time, with
symptoms typically developing only after the disease is advanced. In the
early stages, aortic stenosis often is not detected unless a
characteristic heart murmur (abnormal heart sound heard with a
stethoscope) or other clue is discovered on a physical exam and then
evaluated with further tests.
Severe Aortic Stenosis Symptoms
Shortness of breath
Dizziness or fainting
As aortic stenosis worsens, the heart must work harder to push blood out
to the body and to make up for blood that may leak backward. The extra
work of the heart and reduced blood flow to the body lead to symptoms.
The strain on the heart causes the heart to weaken, increasing the risk
for heart failure and death. Studies show that without treatment, 50% of
people with severe aortic stenosis will not live longer than an average
of 2 years after symptoms develop.
If symptoms or signs (e.g., a heart murmur) suggest aortic stenosis,
further tests are needed to confirm the diagnosis, determine the
severity of the condition, and guide treatment. At Lankenau Medical
Center, patients have access to the most advanced tools and technology
available to screen for, diagnose, and evaluate heart disease. Tests
used in the diagnosis and evaluation of aortic stenosis may include:
(“echo”). An echo uses sound waves to create
images of the heart. The images are made with the use of
an ultrasound device that is either passed over the
chest (transthoracic echo) or guided down the throat
into the esophagus (transesophageal echo). It is the
most common test used to diagnose and determine the
severity of aortic stenosis; it also provides key
information needed when evaluating patients for valve
catheterization. Cardiac catheterization is
helpful in determining the extent of aortic stenosis. It
also is used to evaluate blood vessels used to reach the
heart during a transcatheter aortic valve replacement
procedure and to detect any blockages in the heart’s
blood supply. During the procedure, a thin flexible tube
(catheter) is inserted into a blood vessel in the groin
or wrist and threaded up to the heart. Doctors can
perform several tests through the catheter.
(ECG or EKG). An ECG shows the electrical
activity of the heart. Electrical activity changes in
distinct ways with different types of heart disease,
including aortic valve disease.
studies. Special CT scans are used to
measure the size of the aortic valve and key blood
vessels. Doctors also use the scans to get a “road map”
for the delivery of the replacement valve.
Treatment of aortic stenosis varies depending on many factors,
How severe the disease is (mild, moderate, or severe)
Whether aortic stenosis is causing symptoms
A person’s age, overall health, and other medical conditions
People with mild aortic stenosis may not need treatment but should be
monitored for worsening stenosis or development of symptoms. People with
more advanced (moderate to severe) disease or with symptoms may benefit
Valve replacement. The most effective long-term
treatment for severe aortic stenosis is to replace the diseased aortic
valve with a new valve. The standard approach to valve replacement is
with open-heart surgery. For patients who cannot have surgery or who are
at high risk for surgery, transcatheter aortic valve replacement (TAVR)
may be an option.
aortic valve replacement is proven to relieve
symptoms and improve longevity and is the preferred
treatment option for people with moderate to severe
disease who are well enough to undergo heart surgery.
Surgical treatment options. Aortic
valve replacement surgery may be done as an open
procedure, in which a large incision is made in the
breastbone (called a sternotomy) or as a
minimally invasive procedure. The cardiac surgeons at
Lankenau Medical Center are experienced in all forms of
surgery to replace diseased aortic valves—from
traditional open procedures to minimally invasive
approaches. In 2010, 84% of aortic valve surgeries
performed at Lankenau were done using a minimally
Transcatheter aortic valve replacement (TAVR) is
a new treatment for severe aortic stenosis. The first
FDA-approved TAVR therapy, the Edwards SAPIEN
transcatheter heart valve, is indicated for the
treatment of qualified patients with severe aortic
stenosis who are inoperable or at high risk for
undergoing surgery. A comprehensive evaluation is needed
to determine if a person is a good candidate for TAVR
treatment. TAVR therapy with the Edwards SAPIEN valve is
available at the Valve Clinic at Lankenau Medical
more about this groundbreaking therapy here >
Medications and other treatments. Medications cannot
slow or change the course of aortic stenosis, but they may reduce
symptoms of the disease and help ease the burden on the heart. A
procedure called balloon aortic valvuloplasty can be performed
to help widen the narrowed aortic valve. However, this procedure
provides only short-term improvement of symptoms. It does not treat the
root cause of the problem.
For more information, call 1.866.CALL.MLH.