The aortic valve is a vital component of the heart that acts like a one-way door to regulate the flow of oxygen-rich blood from the heart to the rest of the body. When this valve becomes stiff and narrow, the condition is called aortic stenosis .
This narrowing restricts normal blood flow, forcing the heart to work much harder to pump blood. If left untreated, severe aortic stenosis can lead to heart failure and even sudden death. This condition is progressive (worsens over time), so early detection and regular monitoring are crucial.
Risk Factors and Main Causes
In general, aortic stenosis affects about 5% (1 in 20) of adults over the age of 65. The main causes include:
- Aging and Calcification Process
Scar tissue and calcium deposits build up on heart valves as we age. It's important to note that this calcium buildup on heart valves has nothing to do with the amount of calcium you consume daily.
- Age Factor
The risk increases dramatically from just 1% in one's 60s to nearly 10% as one enters the age of 80 and above.
- High Lipoprotein(a) Levels
High levels of Lp(a) fat particles in the blood are closely related to cases of valve narrowing that occur earlier (before the age of 70 years) and the risk of premature heart attacks.
- Congenital Abnormalities (Bicuspid Aortic Valve)
A normal aortic valve has three leaflets. However, about 1 in 100 people (more common in men) are born with only two leaflets. This genetic disorder makes the valve more susceptible to calcium buildup much more rapidly.
- Other Medical Conditions
History of kidney disease, hyperparathyroidism, autoimmune diseases (such as lupus and rheumatoid arthritis), and history of radiation therapy to the chest area.
Symptoms and Diagnostic Methods
Early signs of valve disease are usually detected when a doctor hears an abnormal sound ( heart murmur ) through a stethoscope. However, a murmur alone is not enough to confirm a diagnosis.
The medical team requires an Echocardiogram (Heart Ultrasound) examination to see the valve structure directly, measure the severity of the narrowing, and confirm the diagnosis.
Many patients with moderate or even severe narrowing don't experience any symptoms at first. However, as the narrowing worsens, common symptoms include:
- Sudden shortness of breath and fatigue, especially during physical activity.
- Dizzy to the point of fainting.
- A feeling of tightness, pressure, or discomfort in the chest area.
Current Monitoring Guidelines and Treatment Methods
To date, no drugs have been proven to completely stop or slow the hardening of the aortic valve, although global research to find new drug therapies is ongoing. Therefore, primary treatment focuses on monitoring and valve replacement.
1. Periodic Monitoring (Repeat Echocardiogram)
The schedule for follow-up cardiac ultrasound examinations is determined by the severity of the disease:
- Mild Stenosis: Re-evaluation is performed every 3 to 5 years.
- Moderate Stenosis: Evaluation must be done once a year.
2. Valve Replacement Procedure (Severe Stenosis)
When the condition has entered a severe stage or begins to cause symptoms, the damaged heart valve must be replaced with a new valve through two method options:
- Conventional Open Heart Surgery: Usually recommended for young patients or patients with complex heart anatomy.
- TAVI ( Transcatheter Aortic Valve Implantation ) procedure: This is a cutting-edge, minimally invasive method. The doctor inserts a new heart valve through a small catheter inserted through a vein in the groin and then guides it to the heart.
Based on the latest medical guidelines, the TAVI procedure is now being proactively offered to elderly patients over 65 who are diagnosed with severe aortic stenosis even if they are not yet experiencing symptoms. This proactive approach is considered a wise alternative to waiting for clinical symptoms to appear, given that most advanced cases ultimately require valve replacement within a few years.
When to Call a Doctor?
If you have a family history of valve disorders, or if you start to experience symptoms of fatigue, shortness of breath when walking long distances, and chest tightness.
EMC Tangerang Hospital offers superior healthcare services, particularly in heart care. Our urologists and surgeons are ready to assist with the latest medical technology and safe, low-risk procedures. We are here not only as a medical team, but as a companion on your journey of recovery, from initial examination to full recovery.
Find the best solution with the latest healing techniques from Dr. Athikah Khairunnisa, Sp.JP, FIHA (Cardiologist and Blood Vessel Specialist at EMC Hospital Tangerang) & Dr. Franky Yesaya Siahaan, Sp. BTKV, K-VE (Thoracic, Cardiac and Vascular Surgeon Specialist, Endovascular Vascular Consultant at EMC Hospital Tangerang).