You went in for your regular doctor’s checkup. You were feeling fine. But your doctor picked up a heart murmur and sent you for an echocardiogram. It turns out, you have aortic stenosis (AS). Now what?

First off, it’s important to understand what AS is. It’s a heart valve disease that’s common in people age 60 and older. With it, your valve opening gets narrower. That makes it harder for your heart to pump blood through it. AS is frequently diagnosed because of a heart murmur. That’s because people who have AS often don’t notice symptoms until it’s advanced.

Vuyisile Nkomo, MD, is an American Heart Association expert and a Mayo Clinic cardiologist with a focus in echocardiography and heart valve disease. He says that if you have AS, your treatment plan depends on how severe your disease is. 

You might not need to treat aortic stenosis right away

Guidelines from the American Heart Association and the American College of Cardiology call for active surveillance as the first step for many people. That means watching to see if your AS gets worse:

  • Mild AS: Screening every three to five years 
  • Moderate AS: Screening every one to two years
  • Severe AS: Screening every six to 12 months

If you develop symptoms, though, your doctor will want to take another look at your treatment plan.

You can have your aortic valve replaced

Nkomo says there aren’t yet medications that can treat AS. “There are efforts to try to find medications that can slow the progression or stop it altogether. Researchers are still working on that,” he says.

Over time, as your AS gets worse, you may need a valve replacement. There are two main options. You could have surgical replacement or catheter-based replacement. “A host of factors go into deciding,” Nkomo says. “It’s a shared decision-making process. It’s made by the heart team in conjunction with the patient.” 

Surgical aortic valve replacement involves open-heart surgery. It’s more invasive, but it’s often a good choice for people who can withstand it. It can also be a good choice for people who have other heart conditions. That’s because surgeons might be able to repair multiple conditions during the same procedure. 

Transcatheter aortic valve implantation (TAVI) is a less-invasive option. It’s a good choice for people who are too frail or high-risk for open-heart surgery. It is also a good choice for people who are at low risk for surgery and do not need other surgical procedures. With it, surgeons thread a catheter through a blood vessel. They access your diseased valve and replace it. 

You’ll also need to consider whether a mechanical valve or a tissue valve is a better choice. With a mechanical valve, you’ll need to take a blood thinner for the rest of your life. But a mechanical valve could last indefinitely. With a tissue valve, you only need to take the blood thinner for one to three months. But tissue valves last 10 to 15 years, on average.

Generally, mechanical valves are recommended for people under age 50. Tissue valves are recommended for people over age 70. That leaves people age 50 to 70 faced with a decision. 

Can you prevent aortic stenosis?

It’s not clear if you can prevent AS. Nkomo says that many of the risk factors for heart disease are also associated with aortic stenosis:

  • High blood pressure
  • High cholesterol levels
  • Obesity
  • Tobacco use
  • Diabetes
  • Kidney problems 

“We don’t know yet whether treating those things aggressively prevents aortic stenosis. We know they are linked to the development of aortic stenosis,” he says. They contribute to other heart problems, though. So, it’s important to manage them with medication and lifestyle modification.

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•January 3, 2021