Recently, I treated Mahesh, an elderly gentleman who had always been active and healthy. Lately, however, he has started feeling short of breath while doing simple tasks like gardening or walking in the house. His condition worsened, and he couldn’t sleep well because he had trouble breathing while lying down. One day, he collapsed while walking down the stairs. When he was rushed to the hospital, Mahesh was diagnosed with aortic stenosis (i.e. one of the valves in his heart had narrowed). To help his heart work properly again, Mahesh underwent a procedure called transcatheter aortic valve implantation (TAVI). The next day, he was back home and soon returned to his usual activities.
Let’s understand Aortic Stenosis
Compare your heart to a busy train station. It has four platforms (chambers) and four gates (valves) that ensure passengers (blood) move smoothly in the right direction. The two upper platforms or atria receive passengers or blood from different parts of the body whereas the two lower platforms or ventricles send the blood out to its destination (i.e. throughout the body).
Each chamber has a gate or valve that opens to let blood through and closes to prevent it from going the wrong way. The most crucial valve is the aortic valve. It allows blood to enter the main artery that supplies blood to the rest of the body.
In aortic stenosis, this valve narrows and does not allow the blood to pass through easily. Hence, the heart has to work much harder to push blood through the aortic valve, causing delays and strain. Due to the reduced blood flow, the patient commonly suffers from breathlessness and fatigue which makes everyday activities difficult. If left untreated, aortic stenosis can lead to serious problems such as sudden cardiac death and heart failure where the heart becomes enlarged and weak.
Factors causing aortic stenosis include:
- Rheumatic fever: An untreated throat infection that damages the heart valves
- Congenital heart defect: A heart problem presents from birth. For example, the aortic valve may have only two leaflets (bicuspid) instead of the normal three (tricuspid).
- Calcium build-up: Calcium can deposit on the aortic valve over time. This is more common in older adults.
- Other factors: Conditions like ageing, diabetes and chronic kidney disease can increase the risk of developing aortic stenosis.
For severe cases of aortic stenosis, replacement of the aortic valve is the only option. There are two main ways to do this:
- Open-heart surgery: This is the traditional method where doctors open the chest to replace the valve. While effective, this surgery comes with risks like blood clots, infections, complications from anaesthesia, and longer recovery times. Moreover, it may not be suitable for older or high-risk patients (e.g. frail, overweight, history of chronic illness or heart disease).
- TAVI: This is a newer and less invasive method where the doctors insert a thin tube (catheter) through a small cut in the leg to reach the heart and replace the valve. Since the doctor does not need to open the chest, TAVI reduces the risk of complications.
TAVI offers significant advantages
Technological advancements have made TAVI even safer and more effective over the past decade. It has several benefits, including shorter hospital stays, less pain, less blood loss, fewer infections, and faster recovery. Patients can often go home the next day and return to normal activities soon after. Researchers are working to make the valves last longer, which could make TAVI an option for many more patients, including younger ones.
Aortic stenosis is a serious condition, but with treatments like TAVI, patients can quickly return to their normal lives. By understanding the condition and the available treatments, patients and their families can make informed decisions and look forward to better health and quality of life.