The heart’s valves ensure that blood flows in the appropriate direction, either carrying venous blood to the lungs for aeration or oxygen-rich arterial blood to all parts of the body.
Heart valve malfunctions affect blood flow and may lead to life-threatening conditions. Aortic stenosis is a silent threat that does not show symptoms until the heart valve becomes damaged, which leads to blood congestion in the heart chambers, followed by heart failure and sudden death.
Aortic heart valve disease
The human heart has four valves – essentially tissue flaps attached to the heart walls. They separate the heart’s chambers and connect to the major blood vessels leaving the heart.
“We divide valvular heart diseases into two broad types: valvular stenosis and valvular insufficiency,” says Dr. Wattanaphol Phipathananunth, Cardiologist “In valvular stenosis the aortic valve that separates the left ventricle and the body’s main blood delivery artery (aorta), does not fully open, which then restricts blood flow to the aorta.”
Dr. Wattanaphol compares the aortic valve to a water valve functioning between a pump and main discharge pipe: when the water valve is closed or partially opened, water cannot flow out freely. Similarly, if doctors can’t fix the heart’s valve, they must replace it.
Aortic stenosis has three levels of severity: mild, moderate, and severe. For severe stenosis, the valve is barely open, requiring valvular replacement. Untreated, valvular stenosis could result in death within two to five years after diagnosis.
Causes and symptoms
Aortic stenosis commonly afflicts the elderly during the body’s natural degeneration. The aortic valve calcifies, which causes it to thicken and narrow. A hallmark symptom is fatigue and exhaustion from everyday activities. Some patients may faint, have tight chest pains, chest oppression, and pulmonary edema making them unable to lay flat. “Patients come to us with general heart disease symptoms of fatigue and exhaustion, but we are unable to pinpoint the specific problem without a detailed diagnosis,” says Dr. Wattanaphol.
Diagnosis requires assessing the patient’s medical history, a general physical examination, and specific cardiac examination (usually an electrocardiogram (EKG) and an echocardiogram) to evaluate the level of valvular stenosis. For levels one or two, a valvular replacement is not required. But in severe aortic stenosis, the physician will consider valvular replacement for treatment.
There are two treatment methods for an aortic stenosis.
- Surgical aortic valve replacement is the standard treatment, which entails open-heart surgery to remove the old valve and surgically implant a new one.
- Transcatheter Aortic Valve Implantation (TAVI) is where the physician inserts a prosthetic heart valve through the femoral artery in the groin or through a small cut on the left side of the chest to get to the apex (tip) of the heart. When the catheter gets in the correct position at the aortic valve, the surgeon releases the new folded-up valve in the delivery system to roll out and replace the degenerated valve.
“If the medical team considers open heart surgery too risky, we recommend TAVI to reduce complications. This method takes about an hour, and the patient receives a small cut from the incision, enabling quick hospital recovery of only five to seven days. The standard surgical method may require two to three months of recovery,” says Dr. Wattanaphol.
Surgery is not the solution for all
Although surgery is a highly effective standard treatment for aortic valvular stenosis, not all patients are able to receive it. This major surgery requires general anesthesia, use of a heart-lung machine, and may take up to three to four hours. Some patients may not be able to withstand such an intense surgery, especially the elderly, or those who have previously had open chest operations, and those with several underlying diseases. The surgical mortality rate is substantially high for these patients.
TAVI requires preparation, expertise, and collaboration among medical professionals such as cardiologists, cardiac surgeons, anesthesiologists, ultrasound physicians, skilled nurses, and physical therapists. The TAVI team at Bumrungrad has been internationally trained and can explain the treatment options and procedures to patients and their relatives.
Above all, Bumrungrad International Hospital values the quality and standards of patient care. Our medical team provides patients with thorough and rigorous care, including diagnosis, meeting with families before and after the treatment, and close follow-up, to ensure that our patients receive the best care in regaining health.
Suitable candidates for TAVI
- Patients with severe aortic stenosis
- Elderly patients, especially those over 80 years of age
- Patients with underlying conditions such as lung disease, aortic atherosclerosis, or who have previously received cardiac surgery
- Patients with high surgical risk, as determined by the attending physician who assesses appropriateness using standard risk-factor analysis
- Patients estimated to live longer than one year, and who do not have advanced cancer
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