Severe Aortic Stenosis - Definition, Criteria, Symptoms, Surgery & More!
Wow! Talk about a response!
The comments and emails for “Heart Valve Stenosis - The Severity Of This Valve Disorder” have been non-stop for the past 24 hours. Thanks to everybody for sharing your thoughtful ideas, patient stories and questions. It’s great to see everybody participating in this discussion about aortic stenosis.
As I previously wrote here, I was alarmed by the mortality rates presented by Dr. Hong. From your comments, it appears you shared those feelings. To help, here is some additional information specific to severe aortic stenosis as they relate to your questions and comments:
For clarity on the definition of severe aortic stenosis, I emailed Dr. Eric Roselli, heart surgeon at The Cleveland Clinic, to get his expert opinion on the use of this term.
Eric Roselli, MD - Heart Surgeon
The Cleveland Clinic
Doctor Roselli referenced the AHA/ACC guidelines for heart valve therapy in which the severity of aortic stenosis is defined by valve area, velocity and gradient. The following table was posted at The Cleveland Clinic’s website.
As the chart demonstrates the severity of aortic stenosis is segmented by the following:
- Gradient. A normal aortic valve has no gradient. If the aortic valve mean gradient is <25 mm Hg, the stenosis is mild; if the mean gradient is between 25 mm Hg and 40 mm Hg, the stenosis is moderate; if the mean gradient is >40 mm Hg the stenosis is severe.
- Valve Area. A normal aortic valve area is >2 cm2. If the valve area is between 1.5 and 2.0 cm2, the stenosis is mild; if the valve area is between 1.0 and 1.5 cm2, the stenosis is moderate; if the valve area is between 0.6 and 1.0 cm2, the stenosis is moderate-severe; areas of less than 0.6 cm2 constitute severe aortic stenosis.
- Aortic Velocity. As for velocity, mild stenosis is between 2.5 and 3.0 m/sec; moderate stenosis is between 3.0 and 4.0 m/sec and severe stenosis is >4.0 m/sec.
As Dr. Hong used the term severe aortic stenosis in his report, I am hopeful he used similar criteria for for his research - although I cannot confirm that because I don’t know Dr. Hong nor have I reviewed the methodology of his study.
Regarding Roberta’s point about the need for aortic valve replacement only when symptoms manifest, I believe it is critical to remember the every patient case is different.
“Why does Adam say that?” you may be wondering.
Well… I think back to my situation. I had only ONE symptom manifest prior to my aortic valve replacement. Yet, my heart was already dilated and my echocardiogram showed a very diseased valve. And… When two different cardiologists and two different surgeons reviewed my echo all four physicians were in a calm shock that I was not more symptomatic.
I’ll never forget what Dr. Starnes said to me during my first exam at USC. Doctor Starnes said, “Ummm…. Adam… Are you sure you haven’t had any symptoms like shortness of breath? You haven’t, maybe, fainted lately? Become dizzy at all? Or, anything like that? Because your valve is in really, really bad shape.”
For me, the signal was loud and clear. Waiting around for symptoms to manifest could have been catastrophic, if not, deadly. I like what Carol wrote in her comment. She stated, “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 just won’t pump. Be thankful that we have the technology to monitor this before a cardiac cath & surgery are indicated.”
Again, I would stress that every patient case is unique. Please consider that as you evaluate your own diagnosis and the possibility of surgery to correct heart valve stenosis.
I hope this helps you digest some incremental thoughts on the topic of severe aortic stenosis. Like I originally noted, this data was quite alarming to me. I hope it helps others prevent any serious health issues going forward.
Thanks again for your comments! If you have any other thoughts, please click here!
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 30th, 2009 at 4:24 pm
Hi Adam - Thank you for all of the information and optimism. I have a question. I have aortic stenosis which was diagnosed in September after a routine physical. I am in the moderate range and am not sure if i am totally without symptoms because i am occasionally dizzy but only slightly. My question is why is it necessary to wait until the severe stage is reached to have valve replacement surgery? Would it not be beneficial to do the surgery in a somewhat ‘preventive’ manner. The information in the January 28 blog from Dr. Hong was troubling. Is it imperative to get sicker before one can be made well?
I live in Chicago and am working with Loyola hospital. I have not gotten a second opinion yet. The waiting just seems counter intuitive to me. If you know of any resources that might answer this question I would appreciate it. Once again thank you for your kind support and positive outlook.
Kathleen
January 30th, 2009 at 8:56 pm
At two months prior to operation my stats were aortic valve area of 0.8 mean pressure gradient was 49, and the maxium volocity was 4.6. First opinion wanted me to come back in six months for a re-check because I didn’t show symptoms. Lucky we got the 2nd opinion who said “now!”. Lesson: no symptoms condition can be very misleading. the stats tell the story.
January 31st, 2009 at 10:33 am
After being diagnosed with moderate AS, my valve remained stabel for about three years with an opening around 1.0 sq. cm and it was decided to go two years before my next echo. I was having no symtoms and was told that AVR was inevitable but putting it off as long as reasonably possible was the way to go.
Last Oct. my new echo showed a measurement of .65. Wow, what a change! My only symtom was slight shortness of breath on occasion which I figured was probably normal for a 55 year old guy in good health. My dr. said I should consider AFR within the next six months. A 2nd opinion suggested the same thing. I had surgery at Cleveland Clinic on 12/29 and recovery is going great.
I think the general thought is to put off AVR as long as reasonably possible because regardless of wheather a mechanical or tissue valve is used, there are down sides to consider over the remainder of our lives. Valve degredation doesn’t happen over night and once diagnosed, there is usually time to have a tentative plan in mind for when you have to decide. In my opinion, diagnostic technology is getting so good that doctors usually have a safe window to work with you until surgery is absolutely necessary. Although an added cost to the health care system, I still think a chest echo should be a must for all people in order to get a baseline even when they are asymtomatic. More lives could be saved.
February 14th, 2009 at 4:39 pm
Adam or anyone, Could you recommend a heart surgeon in the KC area? I must find one within 30 days for an aortic valve replacement. Please. Barb L.
February 19th, 2009 at 3:37 pm
hi. my name is nicole carter. my husband johnny, had his aortic valve replaced nov.19,2008.he owns his own business hes a contractor. he has built homes,metal bldg. ect. ALL his life. he began with his dad when he was just a boy. he has always been active(he turned 52 in dec.)working 6 days a week very physical, always on the go. he also drag races. now days since his surgery he dont want to do anything.it takes all hes got to take a shower. he dont sleep @ night. he wakes up every 45 min. he dreams constantly, wich makes him wake up.he never had symptoms of aortic stanosis only a murmur. he broke his hip last nov.2007 and had screws put in, so he was down 3-4 months & in the process tore his rotatorcuff in the process. we went in for a clearence from his cardiolgist & the next thing we know hes having his valve replaced by a cow valve. hes also diabetic. they put him on zocor, & topral for his heart. how can he get past this depression, he has no emotion. he says he dont feel like himself @ all. he has no zest for life anymore. could it be the meds? or the combo. of meds hes on? im really concerned about him. he just has no energy, no want to. any suggestions from anyone id appreciate. my e-mail jandncarter5113@yahoo.com
May 31st, 2009 at 3:25 pm
Two months ago I visited 2 different cardiologists to read my latest echo. My aortic valve area was measuring at .70 cm2 and my pressure gradient was 43 mmHG. One doctor (a valve specialist) told me to come back in 6 months for a follow up. The second cardiologist took one look and said “Cardiogram first thing tomorrow morning and meet with the surgeon in the afternoon”. Guess who I listened to! It will be 6 weeks tomorrow since my operation. Stephen R.
August 5th, 2009 at 2:00 pm
Adam, I have read and returned for reference to your book numerous times over the last two months. I am still in a “moderate” range of stenosis from a bicusbid valve, and am working through some 2nd opinions, etc. Thank you so much for posting the guidelines for severe stenosis. I have looked through Mayo, Cleveland Clinic and other sites and have had great difficuty in locating specific answers to what the numbers all mean. Your post is very helpful to me as I am looking over the three echos i have had in the last three months. This blog and your research are valuable resources for those of us facing this surgery, whenever it may need to occur. Sherry
January 29th, 2010 at 4:59 pm
my mother in law is 84, she just had a spell with conjestive heart failure. the cardioligest reccomended valve surgery, her aortic valve is leaking, and he said that was part of the cause, can u tell me the motality rate for a 84 year old woman, usually active.
January 29th, 2010 at 11:40 pm
I have a bicuspid valve and was on an every 6 months echo schedule with my cardiologist. I started having shortness of breath upon climbing stairs after 39 years of no symptoms other than my murmur. Two weeks ago I went for an echo and it showed significant changes from the one I had November 2009. I then had my cardiac cath Wednesday Jan 27th 2010 and am scheduled for a TEE on Feb. 8th. I am concerned because my cardio could not find a wire/cath small enoughto fit the camera in my aortic valve to take a measurement. I am concerned because I think that if he could not get the measurement that that would be indicator enough to go on ahead & schedule my AVR. Any thoughts, anyone?
January 30th, 2010 at 6:43 pm
I hear anxiety in your blog post and can empathize with you. At the age of thirty-five, my Aortic valve failed due to congenital aortic stenosis. My first concern was the surgery that was eminent, followed by; what type of life am I going to have with a man-made heart valve. That really translates to “will I be able to watch my sons grow up”? It has been 25 years now, and I am 60. My check ups with the cardiologist is now every 6 months due mainly to my age. I have a mechanical valve and take coumadin daily. This amounts to a finger prick once a month. Unfortunately there is no “if” for you, only a when. Do your own research and pick your own type of valve before your valve fails. Do not let an aversion to coumadin drive your decision. If coumadin were not safe, the FDA would not let it be used. There are more patients in Atrial Fibrillation on coumadin than mechanical valve recipients. Research the mechanical valves as well as the tissue valve.
HAL