Heart Valve Stenosis - The Severity Of This Valve Disorder
I was just listening to Dr. John Hong, M.D. discuss aortic stenosis on a webcast.
The data shared by Dr. Hong was quite alarming, even for me (considering my ongoing research into heart valve disorders). Specifically, Dr. Hong presented mortality rates for asymptomatic patients diagnosed but not treated for aortic stenosis, one of the more common heart valve disorders.
What caught me by surprise, during Dr. Hong’s discussion, was the significant mortality rates of patients with severe aortic stenosis.
As you can see on the chart above, a diagnosis of aortic stenosis should not be treated lightly - as 74% of asymptomatic patients die after 5 years without treatment (aortic valve repair or aortic valve replacement).
Had I known this information, I would have never skipped any of my yearly echocardiograms following the initial diagnosis of my bicuspid aortic valve in 1977. Although I was asymptomatic and my heart was dilated at the time of my secondary diagnosis (in 2005), luckily I had aortic valve replacement prior to congestive heart failure.
Phew!!!
I am hopeful this information helps you best understand how critical it is to continually monitor mild, moderate and severe cases of heart valve stenosis.
Keep on tickin!
About The Author: Adam Pick is a double, heart valve surgery patient and author of The Patient’s Guide To Heart Valve Surgery, a unique book which integrates the clinical facts of heart valve surgery with the personal experiences of 78 former valve surgery patients. To learn more about Adam and his heart valve surgery book, click here.
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January 28th, 2009 at 2:14 pm
I wonder how many people are walking around with unknown severe stenosis, but having no symptoms? My bicuspid valve was found almost by accident in 2001. I had surgery last November (about eight years later), and felt great during that entire period leading up to the surgery date. I was walking around with a pressure gradient of almost 60 mmHg across the aortic valve, running a mile or two each day and never once had any issues. Had my GP not sent me to a cardiologist I am certain I would still be going through life with no idea what was going on with my heart.
These statistics are interesting, and they’re a little scary. They not only show the necessity of monitoring stenosis, but also the importance of basic physicals. Thanks for posting them, Adam.
January 28th, 2009 at 2:57 pm
Adam, your post needs a little clarification…are these mortality rates applicable to those diagnosed within the AHA/ACC guidelines for “severe” stenosis? It’s not clear in the graphic exactly what degree of stenosis these mortality figures apply to. Can you please clarify this? Thanks.
January 28th, 2009 at 3:32 pm
I have aortic stenosis and my cardiologist is monitoring it evry 6 months. I am curious as to the definition of “Severe”. I work out on a treadmill every day for 20 minutes and have no issues, no pain, no shortness of breath. I do 20 minutes at about 3.5 miles per hour on 0% incline.
My cardiologist said that at the current time the mortality rate of my conditiuon if untreated is about the same as that of surgery.
January 28th, 2009 at 4:05 pm
Adam: I too, am interested to hear your response to Jim Kelly’s posting dated this date. I have asymptomatic “moderate” stenosis and was questionning these mortality rates too. If you can clarify, it would be appreciated. Thanks.
January 28th, 2009 at 4:23 pm
Read with interest your posting on the high mortality rate for ASYMPTOMATIC aortic stenosis. I had an AVR 4 months ago and was asymtomatic prior to the surgery (I had severe AS for about 3 years prior). I had relied on the recommendations from the American College of Cardiologists that essentially say (unless they have be very recently changed) that most patients with AS should have AVR postponed until symptoms appear. My Cleveland Clinic surgeon told me that the tendency is to, in effect, follow Dr. Hong’s advice.
January 28th, 2009 at 5:17 pm
Hi Adam,
Could it be that Dr. Hong was referring to statistics for ’symptomatic’ and not ‘asymptomatic’ patients? I, too have severe aortic stenosis and was told that unless I have symptoms my lifespan is supposed to be the same as age related cohorts. The cardiologist explained that once symptoms develop lifespan can be shortened and AVR is required.
Any clarificiation would be appreciated!
January 28th, 2009 at 6:23 pm
The determination about when to surgically intervene with AS is “all about the numbers”, rather then the symptoms. My numbers were “stable” with moderate AS for 11 years, then in my 6 month followup echo I had progressed to severe AS. I had never felt better in my life! The way it was explained to me was really rather simple. Years ago, it was very common for people with AS to present to the ER with “Sudden Death Syndrome”. Once the valve becomes so stenotic, all the CPR & cardiac drugs in the world won’t resuscitate you! Your heart valve just won’t pump. Be thankful that we have the technology to monitor this before a cardiac cath & surgery are indicated.
January 28th, 2009 at 7:12 pm
I concur having had few if any symptoms. When the surgery occured Monday last the surgeon was alarmed how bad it had become. Bi-leaflet valve birth defect and at 66 years of age those two leaflets were fused by the calcilum build-up. 30 more days? Not likely in my case. Our family decision to proceed now saved my life. New Bio-core Ultra Epic is doing well!great and good for at least 15-20 years. New ascending aortia of woven Dacron as well. 3-1/2 hour surgery by awesome team at St. Vincent’s Cardio Vascular Institute in Portland, OR, on Monday at 11am, out of CRU in 24 hours and home Saturday! ps, hospital bed was horrible! Made by Stryker. Don’t they make armored vehicles for the Marinews?
January 28th, 2009 at 8:31 pm
Adam,where can I hear Dr. Hong’s webcast about asymptomatic AS.
I am 83 without any problems and I work out as hard as I can to see if my heart will attack me and all I get is stronger. My Valve area is 0.8cm and I should be dropping but nothing. I really don’t want to waste time recovering from surgery which would probably be a couple of years at my age and be restricted from hard active physical activity. The odds are against me.
your book is excellent..
thanks
January 28th, 2009 at 10:37 pm
I have an appointment to have AVR on 2/13/09. Had final meeting with surgeon and required testing done today. Was first diagnosed with AS in Dec. 07 but doctor took the wait & see approach. In Dec. 08 he said it was time to pursue surgery. Had some tests and everything came back–do it now. Had very few symptoms except some shortness of breath and tired, but since I also have COPD didn’t know which was the problem. Surgeon today seems to think the COPD is not that bad….that the problem of breath and tiredness will improve considerably after the surgery. Anyway, I’m not willing to risk waiting any longer as the alternative to surgery is a bad option. I’m also going with a mechanical valve even though I’m 67. My family history and my current health other than the AS indicate I could live into late 80s or early 90s and I do not want to risk another surgery in my early 80s….my body is liable to be a lot more frail by then. I am just really thankful that the AS was found when it was.
January 29th, 2009 at 10:02 am
Adam,
My father is diagnosed with “moderate AS” Aortic valve is currenly 1.6 cm. His Dr. at MGH suggests waiting. I am interested in hearing what other people think. He is 84.
Robert
January 30th, 2009 at 11:16 am
I discovered that I had severe AS about five years ago and it stayed for several years around 1 cm. Since it seemed fairly stable, and I was asymptomatic, I went for two years between 2006 and late 2008 between echos. All of a sudden it dropped to about .65 cm and I was told I needed to consider replacement surgery within the next six months. What I had hoped would be years away, hit all of a sudden! I’m a healthy 55 year old guy and decided to do it asap. I had surgery on 12/29 at Cleveland Clinic and things are going great during recovery. I chose the tissue valve and may need to do this again down the road, but chose that option rather than the mechanical valve and Cumadin the rest of my life.
January 30th, 2009 at 3:43 pm
I am 61. Last December my heart murmur was diagnosed as being “worse” ( .6 cm). Two echocardiograms and a cardiac catheterization later I now am awaiting my surgery date for replacement of my aortic valve. I have led a very active life and want to continue this so I have chosen… with my physicians guidance… the carpentier edwards pericardeal bovine magna aortic valve. I would appreciate hearing from anyone that has experience… personal or professional… with this valve. Thanks.
May 19th, 2009 at 11:47 am
I was diagnosed with AS about 5 years ago and have been treated with only a beta blocker. I am female , 57 years of age, non smoker. I was told AS is somewhat rare in females, but my condition was probably inherited. My son has apparently inherited this condition. He is also being treated with a beta blocker. He seems to be symptom free at 38, but I have had symptoms off and on since it was discovered. I just had another echo and apparently things have progressed and I am waiting on the results to find out what I need to do. I must say, this is VERY scary.