A less invasive approach to a heart valve disease

Due to shared lifestyle risk factors, aortic stenosis can sometimes be mistaken for myocardial infarction, more commonly known as a heart attack. The latter often arises when blood flow to the heart is reduced or blocked by atherosclerosis, resulting in poor oxygen supply to the heart muscle. Without the prompt restoration of blood flow, the affected heart tissue will die. 

Similarly, aortic stenosis-related symptoms overlap with those of atrial fibrillation, a condition characterised by the erratic and occasionally rapid contractions of the heart’s upper chambers, known as the atria. This irregularity could hinder the heart muscle from relaxing properly between contractions, ultimately diminishing its overall efficiency and performance. Atrial fibrillation has a broad range of causes, including congenital heart defects, obstructive sleep apnea, high blood pressure and narrow or blocked arteries. 

Dr Kuntjoro acknowledges that it may not be easy for a layperson to differentiate between the different types of cardiac conditions. “In any circumstance, it’s imperative not to disregard suspicious symptoms and to seek prompt medical attention. Early diagnosis and intervention are essential for optimal patient outcomes,” he said.  

ENHANCING DISEASE MANAGEMENT WITH EXPANDED TREATMENT OPTIONS

When it comes to treating aortic stenosis, Dr Kuntjoro shared that there are four pathways most commonly recommended. 

The least invasive line of treatment is medication, which offers temporary relief from symptoms but does not address the underlying valve issue. Over time, its therapeutic effectiveness could also diminish, he added.  

Another non-surgical symptom relief option is balloon valvuloplasty. Said Dr Kuntjoro: “However, there is a risk of valve re-stenosis over time, and it is not deemed a long-term solution due to its limited durability.”

When considering surgical approaches, one option is surgical aortic valve replacement (SAVR), a procedure that involves replacing the aortic valve with a mechanical or biological valve, derived from animal or human tissue. 

Dr Kuntjoro explained: “While mechanical valves last longer, patients will need to take blood-thinning medicines perpetually. On the other hand, biological valves need to be replaced after 10 to 15 years.” 

He pointed out that SAVR is an open-heart procedure that carries inherent risks, especially for elderly patients and those with underlying conditions, and may not be suitable for all candidates. “Additionally, patients who undergo SAVR typically spend a minimum of seven days in hospital before embarking on a prolonged path to recovery,” he said.  

The veteran cardiologist shared that the latest addition to the treatment of aortic stenosis is transcatheter aortic valve implantation (TAVI).