As 2014 began, this man’s rest was becoming increasingly frequent.    He had just been scheduled to have an open heart surgery to replace a narrowed aortic valve, due to aortic valve stenosis.  We had known about this condition for over two and  a half years, because his routine health check up had revealed a heart murmur for the  first time.

The aortic valve prevents the blood pumped from the left ventricle from slipping backwards to where it came from, and is necessary for an efficiently working heart.   Over time some people’s aortic valves become hardened, usually with a calcified, bone-like material, and narrowed.  When this happens, the amount of blood which the heart can pump out per beat is diminished.

When a new heart murmur develops,  it can be due to aortic stenosis.  The next step that the medical system recommends, is to get an echo-cardiogram  This  yields information about the cross sectional area of the aortic valve,  any ventricular enlargement to deal with a harder job to pump the blood out to the body, the pressure gradient that occurs in this pumping, and the total amount of blood  pumped to the  body per beat.  

This man’s first echo-cardiogram two and a half years ago showed that his murmur was indeed due to aortic valve stenosis which was at the time, categorized as moderate to severe, with a cross-sectional area of 0.8 square centimeters.  A normal cross-sectional area is about 2.5 square centimeters, and anything over 2 square centimeters is considered normal.  There is no known medical or dietary prevention or intervention which can alter or slow the development of this condition.  The only treatment is open heart surgery to replace the defective valve with an artificial valve or a treated tissue valve.   The condition progresses relentlessly, if not steadily.

Usually, the person waits to have surgery  until after this heart condition causes symptoms of pain, dizziness, or breathlessness.  They say that if the valve area becomes so small that the condition is critical, the valve should be replaced even if one does not have symptoms.  If a symptomatic or critical aortic stenotic person does not undergo the valve replacement surgery, the person is will likely die within a couple of years.

The reason that it is recommended to wait until symptoms appear is that the valve replacement surgery itself carries perhaps a 1% chance of death due to the surgery, and perhaps a 5% chance of stroke associated with the surgery.

This man’s valve condition was checked periodically with an echo-cardiogram, until it became severe, and had a cross-sectional valve area equal to about one fourth that of a normal valve.  He did not experience symptoms, except for a reduced amount of time each day in which he could do every day things, and an increasingly lower amount to be accomplished in a day, and increasingly more resting, shown above.

His cardiologist recommended at the beginning of December that he see a cardiothoracic surgeon.  So he saw the surgeon in mid-December, who, after reviewing his brand new echo-cardiogram, which showed that his aortic cross-sectional area had shrunk further to 0.6 square centimeters, recommended surgery within three weeks of that time, early in 2014.   Thus continued this open heart surgical experience.