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The Medical Minute: Ensuring heart valve health

Heart valves control the direction of blood flow, and when something interrupts their precision, the effect can be dire.

Aortic valve stenosis, according to the American Heart Association, is the most common and most serious of valve disease problems. It occurs when a narrowing of the aortic valve opening prevents blood from the left ventricle from flowing to the aorta. It also can affect the pressure in the left atrium.

Progression of aortic valve stenosis is slow. It can take many years to develop into a life-threatening problem.

“Not everyone will be at the same pace, but the valve does worsen,” said Dr. Mark Kozak, a cardiologist with Penn State Health. “The only thing one can do is report symptoms and stay in contact with a cardiologist.”

The main signs and symptoms of this disease are shortness of breath, chest pain and passing out, but they might not start right away.

“All three of these symptoms should not be taken lightly,” Kozak said. “People can do well over a long period of time, but once the symptoms develop, it tends to be pretty rapid. Most people die within a couple years if left untreated and unmonitored.”

While aortic stenosis can be found in some younger people, it’s more common in people age 60 and older. “Because our population is aging, there’s a mini epidemic of stenosis in our 80-plus generation,” he said.

Younger aortic valve stenosis patients are usually born with a defect that causes stenosis that are detected in infancy or childhood.

Heart murmur patients should consult with a cardiologist to rule out aortic valve stenosis.

“Many people with aortic stenosis never follow up on a murmur, and they then may come to the hospital seriously ill instead of having their slow progression tracked in a timely fashion – allowing for time to treat the disease at an appropriate moment,” Kozak said.

Everyone should exercise and eat healthy, but for heart patients it’s doubly important, since a robust physical constitution helps them tolerate the surgeries and procedures they must endure. Additionally, staying active can help their physicians understand how their stenosis symptoms are progressing.

“People used to be afraid of exerting themselves when they were diagnosed with aortic stenosis, but it’s important how active you are and when symptoms become noticeable,” Kozak said.

He added that the human body – even one afflicted by stenosis – will often naturally stop itself before over exertion.

“It’s better to have people exercise and stay healthy, than restricting their physicality,” he said. “As I monitor their progression, if I think a valve has reached a point of concern, it’s time to replace it.”

Valve replacement is the only effective method for treating severe aortic stenosis. In recent years, doctors have been using a less invasive valve replacement procedure using a catheter-base technique — also known as transcatheter aortic valve replacement (TAVR).

TAVR uses a hollow tube that is inserted at an access point in the body, usually the leg or the chest. The tube is guided through the blood vessels, to the heart and into the aortic valve, allowing for the replacement valve to be securely placed. Once secured, the catheter is withdrawn.

With catheter-based replacement procedures, most people go home the next day and recovery takes about 72 hours.

“When it goes well, the recovery is faster with catheter valves,” Kozak said. “Catheter valves aren’t better and are only marginally safer, but the speed of recovery is vital, especially for our patients who are 80 or older.”

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The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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