AORTIC STENOSIS
Only about one half of cases of aortic stenosis are related to rheumatic heart disease, the remainder being due largely to a congenital abnormality. In this syndrome, the opening through which the blood passes from the left ventricle to the aorta (and thereby to the rest of the body) becomes markedly narrowed. The ventricle squeezes increasingly harder, but eventually can no longer meet the challenge.
Symptoms
For many years the heart may compensate for the abnormality by contracting more rapidly and vigorously. After such a latent period, symptoms may progress very rapidly, at which time surgical treatment may sometimes be too late. The primary symptoms are: a) angina, due to inadequate blood flow through the coronary arteries arising from the first part of the aorta, b) fainting, due to either blood pressure drop after exertion or position change or to rhythm irregularities, and c) heart failure, as described elsewhere, with shortness of breath, shock, and ultimate death.
Diagnosis
Exam findings are combined with the history, echocardiogram, electrocardiogram, x-ray, and finally cardiac catheterization in some cases to confirm the diagnosis, similar to mitral disease as noted above.
Treatment
Although medications such as diuretics or digoxin may be useful to control some of the symptoms, this disease is best treated with surgery. The difficulty is to determine when to operate.
Since many years may elapse before symptoms develop, immediate surgery for some cases may be unwarranted. On the other hand, waiting too long may increase the surgical risk, since the heart is less able to withstand the stress of the surgery. Given all the survival statistics, catheterization data, and development progression of symptoms, most authorities advise relatively early surgery in children and young adults, and a bit more patience in adults when possible. Five year survivals after surgery range from 60 to 95%, depending on the severity at the time of surgery. Without surgery survival is poor once symptoms develop.
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