Aortic stenosis is one of the most common heart diseases in the elderly population. Global figures show a prevalence of around 5% worldwide, mainly among males.
Aortic valve stenosis occurs when the aortic valve becomes progressively more rigid and, therefore, its full opening is compromised. This will then create an obstacle to the blood as it exits the heart to the rest of the body.
However, if this disease occurs in younger people, the most common cause is a congenital defect that affects the valve, such as a valve with only two cusps instead of the usual three, or with an abnormal funnel shape.
People who develop this disease, caused by a birth defect, may not show symptoms until adulthood. Still, the main associated symptoms are chest tightness (angina) during exertion, fatigue, shortness of breath and fainting. Once these symptoms appear and if the aortic valve is not replaced, patients with severe aortic stenosis have a survival rate of only 50% at two years, and 20% at five years.
Aortic stenosis is a serious disease when not detected in time. It increases the risk of heart attack, stroke or death. Identifying and controlling risk factors is important.
Diagnosis is reached through a physical examination — auscultation — and an echocardiogram, the latter being the best option to assess the severity of the disease.
In people who are asymptomatic, a heart stress test is also recommended. Early detection of aortic stenosis reduces hospital admissions and represents added quality of life.
As far as the most appropriate treatment is concerned, the decision is reached by a multidisciplinary team consisting of doctors from different specialties as it means a new heart valve is necessary.
The procedure consists of a catheter being introduced through an artery (generally in the groin), without the need to stop the beating of the heart. This minimally invasive technique is, for many specialists, the greatest advance in cardiology in the last 20 years.
The HPA Cardiovascular Intervention Unit has been working since 2001 and has been constantly evolving, always a pioneer in diagnostic techniques, but, above all, in minimally invasive surgical interventions.
The last innovation occurred in 2017 with a transapical percutaneous or transcatheter aortic valve replacement. This technique has revolutionised the approach to aortic stenosis, permitting non-surgical replacement of the aortic heart valve in patients with severe cases of this condition, such as those that are inoperable or those that are at very high risk for open-heart surgery.
When there is no access route to the heart to replace the valve with a minimally invasive procedure, the solution is to make a small incision of approximately 4cm under the breast, to reach the heart directly through the apex.
This intervention requires great coordination between the team of cardiac surgeons and the team of interventional cardiologists, the specialists who make up the Heart Team of the Cardiovascular Intervention Unit at the HPA.
Article submitted by Hospital Particular do Algarve