Severe Aortic Stenosis: 'Timely Treatment is Crucial for Survival'

It’s a troubling fact that, for some people, heart valve disease progresses very slowly, so that the symptoms — such as fatigue, shortness of breath, dizziness and palpitations — are barely noticeable. Or, you can have no symptoms at all, even if the disease is severe. But left untreated, some types of heart valve disease can have serious and potentially fatal complications.

“About 25,000 people die from heart valve disease each year. For those with severe aortic stenosis — the most dangerous type of valve disease — the survival rate is low when left untreated. Survival is only 50 percent at 2 years after the onset of symptoms and 20 percent at 5 years without treatment,” interventional cardiologist Srinivas Iyengar, MD, of Boulder Heart told a crowd of more than 115 people during a free health lecture held on Oct. 11 in Boulder.

“Fortunately, there have been major advances in treating heart valve disease,” he said.

Heart Valve Disease: A Problem of Faulty Heart Valves

The heart has four heart valves that control blood flow into and through the heart. They are the aortic, mitral, pulmonic and tricuspid valves.

“Heart valve disease occurs when a valve becomes damaged, leading to a backflow of blood or complete blockage of blood flow. Although problems with heart valves are often linked to age-related factors, sometimes they can develop from illnesses such as rheumatic fever or infective endocarditis,” Dr. Iyengar said.

Two main problems can occur with these valves: regurgitation and stenosis. Regurgitation occurs when a valve does not fully close and allows blood to leak backwards. This is commonly referred to as a leaky valve. Stenosis is the narrowing of a valve that prevents blood flow. It is often described as a tightening valve.

Any of the four valves can have regurgitation or stenosis – sometimes both – but the mitral and aortic valves are most likely to be damaged:

• Mitral regurgitation is the most common type of heart valve disease. The valve becomes “leaky,” allowing some blood to spill backwards into the lungs rather than going forward into the heart’s left ventricle.
• Mitral stenosis is a narrowing or tightening of the mitral valve opening that restricts blood flow from the left atrium to the left ventricle.
• Aortic regurgitation is a leakage that sometimes allows blood to flow backwards from the aorta into the left ventricle. It can also be found in conjunction with aortic stenosis.
• Aortic stenosis is a narrowing of the opening of the aortic valve that restricts blood flow through the valve and eventually causes damage to the heart itself.

Aortic Stenosis: Untreated Patients Have a Poor Prognosis

Aortic stenosis, the most deadly heart valve disease, is more often seen as an age-related issue that affects about 7 out of 100 people over the age of 65 in the U.S., or about 1.5 million people.

“Many people who have aortic stenosis live without symptoms for many years. Yet once they start to experience even minor symptoms, urgent treatment is critical. The disease progresses rapidly, and when it becomes severe, the prognosis is poor," Dr. Iyengar warned.

According to Dr. Iyengar, symptoms of aortic stenosis can include:
• Shortness of breath
• Dizziness or fainting
• Palpitations or a feeling of heavy, pounding or noticeable heartbeats
• Fatigue or reduced ability to do normal activities
• Chest pain, pressure or tightness

“Many people mistakenly attribute these symptoms to aging and don’t get them checked out,” Dr. Iyengar said. “Yet timely intervention is so important. A simple check with a stethoscope during a physical exam can often identify the disease and save your life.”

TAVR: Newer, Less Invasive Treatment for Aortic Stenosis

Dr. Iyengar explained that medications can help manage the symptoms. However, there are no medications that can reverse aortic stenosis. The only cure is replacing the diseased valve.

Usually, heart valve replacement requires open-heart surgery. During this procedure, patients are connected to a heart-lung bypass machine, which does the work of the heart while their heart is stopped. The old valve is removed and a new one is sutured in place. But open-heart surgery becomes riskier with the older population or for patients not healthy enough to undergo such an invasive procedure.

An alternative to this traditional surgery is a new, less invasive option called Transcatheter Aortic Valve Replacement (TAVR). It involves replacing the faulty valve via a catheter that’s threaded through a blood vessel. TAVR has essentially become the standard of care for people with severe aortic stenosis and whom open-heart surgery is considered too risky.

“With TAVR, your aortic valve is replaced with a new valve while your heart is still beating. It does not require patients to be placed on a heart-lung machine or have their chest opened up,” said Dr. Iyengar.

Results from multiple studies have shown better results in high-risk patients receiving TAVR as opposed to open heart surgery. Also, newer evidence suggests it can sometimes be an option for extending the lives of intermediate-risk patients.

Structural Heart Clinic at Boulder Heart

All hospitals that perform TAVR are required to have a uniquely trained Heart Team that includes a cardiothoracic surgeon and an interventional cardiologist.

“BCH recently formed such a team at Boulder Heart. Only through collaboration with a team can heart valve disease be identified and treated effectively. The ultimate goal is better and more varied options for our patients and our community,” Dr. Iyengar said.

To make an appointment with Dr. Iyengar or if you have further questions about heart valve disease, contact Boulder Heart’s Structural Heart Team at 303-442-2395.

Click here to view PowerPoint slides from Dr. Iyengar’s lecture on “Recognizing & Treating Heart Valve Disease.”

Want to receive notification of special events and lectures? Sign up to receive email notifications.