Wow! Talk about a response!

The comments and emails for “Heart Valve Stenosis – The Severity Of This Valve Disorder” ^[1] 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 ^[2].

As I previously wrote here ^[1], 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 ^[3]Cleveland Clinic ^[3], 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 ^[4] 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 aortic stenosis for 11 years, then in my 6 month followup echo I had progressed to severe aortic stenosis ^[5]. 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 ^[6]!

Keep on tickin!