The essence of this heart defect is the narrowing of the lumen of the left arterial outlet, which hinders the outflow of blood from the left ventricle to the aorta.
In addition to a congenital defect of the aortic valve, the main causes of stenosis are retrograde changes (calcification) within the aortic valve. It occurs with age, more often in men than in women – mainly due to atherosclerosis and calcium disorders. The main risk factors for aortic stenosis will therefore be the same as in the case of atherosclerosis (overweight and obesity, dyslipidemia, smoking). The defect is also predisposed to hyperparathyroidism, diabetes, arterial hypertension, renal failure and rheumatic diseases.
As a result of obstructed outflow of blood from the left ventricle, it is overloaded and hypertrophied. At the same time, there is insufficient blood supply to the heart wall, caused by lowered pressure in the ascending aorta and departing coronary vessels (the only source of blood supply to the heart) and an increased thickness of the left ventricular wall. This leads to further deterioration of the insufficiency and weakens the force of contraction and the ejection volume of the ventricle. As a result, a certain volume of blood remains in the lumen of the ventricle despite contraction, making it difficult for blood to drain from the left atrium and thus from the pulmonary circulation. This sequence of events can lead to the development of pulmonary hypertension.
Aortic stenosis may remain asymptomatic for an extended period of time. Symptoms include angina pain (due to left ventricular wall ischemia), weakness, shortness of breath and palpitations. In extreme cases, sudden cardiac death may occur due to ventricular fibrillation or pulmonary edema.
The defect is noticeable in auscultation, as well as in the ECG and ECHO of the heart. Over time, signs of left ventricular hypertrophy are also visible on the chest X-ray.
With asymptomatic stenosis, the prognosis is good; it worsens with symptoms of left ventricular failure. Treatment it is conservative; in more severe stenosis, surgical therapy is implemented.
Text: SzB
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