Posts Tagged ‘aortic stenosis’

Aortic Stenosis

The aortic valve controls the blood flow from the heart. In aortic stenosis, the valve does not open fully, restricting blood flow from the heart.The aortic valve is tremendously important, controlling blood flow from the heart to the rest of the body. In aortic stenosis, the valve does not open fully, restricting blood flow from the heart. In aortic regurgitation, the valve opening does not close completely, causing blood to leak backward into the heart.

Either of these conditions can cause the heart muscle to pump harder and blood flow to the body may decrease, which can ultimately lead to heart failure. Aortic stenosis and regurgitation may occur with age, often in those older than 70. However, in patients with other heart conditions, aortic stenosis or regurgitation can occur much earlier.

Aortic Stenosis Symptoms

Aortic stenosis and regurgitation may be mild and not produce symptoms. However, over time, the aortic valve may become narrower, resulting in a variety of symptoms including:

  • Fainting
  • Weakness or chest pain (often increasing with activity)
  • Palpitations (rapid, noticeable heart beats)
  • Chronic heart failure
  • Blood clots to the brain (stroke), intestines, kidneys, or other areas
  • High blood pressure in the arteries of the lungs (pulmonary hypertension)

Valve Treatment

Physicians at the Emory Heart & Vascular Center offer a variety of treatment options for patients with severe aortic stenosis. Physicians at Emory perform transcatheter aortic valve replacement for inoperable patients, high risk patients, as well as medium risk patients. Minimally invasive surgical aortic valve replacement can be done in those who are low-risk patients.

The results of aortic valve replacement are often excellent. During transcatheter aortic valve replacement (TAVR), Emory interventional cardiologists and cardiothoracic surgeons place a new valve inside the heart without stopping the heart or opening the chest. Patients often recover more quickly from this minimally invasive approach.


About Dr. Thourani

Dr. Thourani has been heavily involved in the research for structural heart and with the Transcatheter Aortic Valve Replacement trials. Other areas of focus are: valve disease, percutaneous and minimally invasive valve applications, biomedical engineering for treatment of new valve prosthesis and techniques, myocardial protection, coronary artery disease.
Dr. Thourani is the Professor of Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Chief of Cardiothoracic Surgery at Emory Hospital Midtown, and the Co-Director of the Emory Structural Heart and Valve Center.

Emory’s Heart & Vascular Team Make Big Strides in Fight Against Heart Valve Stenosis

Transcatheter Aortic Valve ReplacementEmory physicians recently completed their 200th Transcatheter Aortic Valve Replacement and the United States Food and Drug Administration (FDA) also approved the new transcatheter heart valve, under study at Emory since 2007, to treat severe aortic stenosis.

The device called the SAPIEN valve, developed by Edwards Lifesciences, offers a new non-surgical treatment option for patients with failing aortic valves. Emory University Hospital was one of 23 sites nationwide, and the only one in Georgia, to study transcatheter aortic valve replacement (TAVR) with the SAPIEN valve.

Aortic stenosis is a life-threatening heart condition that affects tens of thousands of Americans each year when the aortic valve tightens or narrows, preventing blood from flowing through normally.

During the TAVR procedure, doctors create a small incision in the groin or chest wall and then feed the new valve made of cow heart tissue, mounted on a wire mesh on a catheter, and place it where the new valve is needed. This offers a non-invasive way for doctors to treat patients who are not candidates for traditional surgery.

This is a major milestone in the treatment of heart disease, the development of this procedure and this FDA approval will allow us to help even more patients with valvular heart disease and could mean the difference between life or death for a countless number of patients who are too sick or weak to undergo open-heart surgery to replace their diseased valves.

My colleague, Peter Block, MD, helped lead the Emory clinical trial, along with surgical colleagues, Robert Guyton, MD and Vinod Thourani, MD.

For more information please visit:

Aortic Stenosis Related Resources:

Dr. Vasilis Babaliaros Emory Heart & VascularAbout Vasilis Babaliaros, MD
Dr. Babaliaros is an Interventional Cardiologist at the Emory Heart & Vascular Center.  He specializes in structural heart diseases. Dr. Babaliaros traveled to France to learn the new lifesaving approach, training for several years alongside cardiologist Alain Cribier, MD, who successfully implanted the world’s first transcatheter heart valve in 2002.  He is an Assistant Professor of Medicine at Emory University School of Medicine.

Emory Heart Valve Study Featured on Fox 5 News

As we’ve pointed out in past blog posts, aortic stenosis refers to the narrowing of the aortic valve. This is most commonly caused by the simple wear and tear of aging. As people age, calcium builds up in the valve, causing it to narrow and restrict blood flow from the heart to the body. Recently, Fox 5 News featured Emory on a news piece describing our work with a new, minimally invasive procedure that is showing great promise in the treatment of this condition.

For more details, you can view the news clip here:

About Vasilis Babaliaros, MD:

Dr. Babaliaros specializes in Internal Medicine and Cardiology, and his areas of clinical interest are cardiology-interventional, valve disease, and valve repair/replacement. He received his Biomedical Engineering degree at Duke University (1992), his MD degree at Emory University (1996), and completed his training in Internal Medicine and Cardiology at Emory (2003). In 2004, he completed fellowship training in Interventional Cardiology at Emory University and then continued sub-specialty training in Valvular Interventional Cardiology under Alain Cribier MD at the University of Rouen, France (2005). He joined the faculty working with Peter Block MD as the Associate Director of the Emory Center for Valvular Intervention and Structural Heart Disease Treatment in 2006.

Revealing Results from Heart Valve Study at Emory

Glenrose Gay of Vidalia: first Emory heart patient to receive new transcatheter aortic valve procedure. Pictured here with Dr. Peter Block (left) and Dr. Vasilis Babaliaros.

As we’ve mentioned in previous posts, Emory University Hospital has been engaged in a clinical trial for patients suffering from severe aortic stenosis since October of 2007. To review: in aortic stenosis, the aortic valve narrows, restricting blood flow from the heart to the body.

Emory is the first hospital in the Southeast to study the non-surgical treatment known as transcatheter aortic valve implantation (TAVI). This procedure involves the replacement of the narrowed valve with a better-functioning synthetic valve from outside the body. We place a small incision into the groin or chest wall, and then feed a wire mesh valve through a catheter, or tube, placing it where the new valve is needed. The technique is ideal for those who are too ill or too frail to endure open-heart surgery.

Emory is one of approximately 20 nationwide hospitals participating in this study; Phase II of the trial compares TAVI to traditional, open-heart surgery or medication therapy in high-risk patients with aortic stenosis.

Last Wednesday, the initial findings of the study were published in The New England Journal of Medicine (NEJM). Specifically, the trial followed 358 patients who received either catheter-delivered valves or standard non-surgical treatment. The results reflected that patients who had replacement heart valves via catheter were more likely to survive a year following surgery than patients who were treated without the replacement of their original valves. The authors of the study went as far to say that catheter-delivered valves “should be the new standard of care” for patients who are unable to undergo surgery.

Although TAVI has yet to be approved by the FDA, we anticipate that the catheter-implanted valves will receive FDA approval by late 2011.

These results are particularly groundbreaking, as the number of people with failing valves is expected to greatly increase as baby boomers continue to age. Overall, this is a giant step forward in our battle against this common disease.

Do you have questions about the heart valve study, or about aortic valve stenosis? If so, be sure to let me know in the comments section.

Percutaneous Valve Replacement Provides A Second Chance at Life

My name is Peggy Adams. I’m a retired schoolteacher, and I live with my daughter and grandson in Pensacola, Florida. I am 76 years old, and I’ve been living with congestive heart failure for years. In May of this year, I came to Emory to undergo valve replacement.

I suffered from aortic stenosis for three years, and because of my heart problems I entered stage IV renal failure. Unfortunately, I have several other health problems, including diabetes, COPD (chronic obstructive pulmonary disease), and arthritis. Over this past year, I reached the point where I was in the emergency room every three weeks. The slightest exertion would send my system into major fatigue. Typically, I’d get out of bed, walk out the door and down the ramp to the car, and by the time I reached my car I’d have to take 10 minutes before I could stop panting. I was just so tired all the time; my eyelids would close in mid-conversation.

When I was in the hospital last December, my primary heart doctor informed me that my valve would eventually stop working completely, and that she didn’t think I had more than six months left to live. She sent me to another doctor who did a workup and predicted that it was closer to three months. He told me that I needed to have my aortic valve replaced, but that he wasn’t willing to perform the surgery due to all of my other illnesses. He believed there was no way I’d survive it.

I wasn’t willing to accept the fact that this was the end. So we started researching and heard about the program at Emory with Dr. Block and Dr. Thourani. They were performing percutaneous valve replacement, where the incision is just six inches below the breast. With this procedure, they wouldn’t have to split my chest open, so the recovery would be much easier. I have a fighting spirit, so I decided that I wanted to go for it.

It was then that we traveled to Emory to take part in an interview to participate in the study. There were all these young doctors in the room who proceeded to ask me many, many questions. I had just one question that I wanted to ask them: “How many times have you done this operation?” They replied that they had performed the surgery 35 times, and I would be number 36. When I asked them about their rate of success and failure, they said that it was 100 percent, and that they hadn’t lost any patients. This was very reassuring, and it gave me a lot of confidence.

So, we came back home to Pensacola to wait for them to call. They told us to prepare to wait eight weeks fro their decision, but after only about three weeks they called and told me I needed to get back up to Emory as soon as possible. I was there by 8 o’clock on a Tuesday morning, and they had me in surgery the next day.

The doctors were very concerned that I’d go into renal failure, or that they wouldn’t be able to wean me off of the ventilator after the surgery. But I surpassed everyone’s expectations. Not only did I not go into kidney failure, but after only three or four days after surgery, I was walking the hallways to show the nurses how well I was doing. Now, here’s the amazing thing about this surgery: On the fifth day, I no longer needed a bandage at all. It healed that quickly and that perfectly. I was feeling good. On Friday, just nine days after surgery, I was back in the car headed home.

When we went back for a follow-up five weeks after the surgery, they gave me an echocardiogram, and my heart pressures were normal. For the first time in years, I had normal heart pressures. My new valve is functioning wonderfully. I sure wish everyone with valve problems could have this procedure instead of having open-heart surgery.

Now, I can go to the movies, I can go to church on Sunday, and I can visit my sisters. Even better, I’m not sleeping through life. It’s amazing. I’m very grateful to the doctors at Emory for giving me a second chance at life.

A Look at Transapical Aortic Valve Implantation

Transapical aortic valve implantation (AVI) is a minimally invasive technique that replaces the aortic valve through the placement of a small incision under the left breast—directly below the heart—without using cardiopulmonary bypass. It’s designed for patients who do not have appropriate sized femoral vessels in the groin for the treatment of aortic stenosis.

Transapical AVI is actually a type of transcatheter valve implantation. There are two ways to go about this sort of implantation: through transapical or transfemoral routes (a transfemoral procedure involves an incision in the groin area).

Transapical AVI is often referred to as an “off-pump” procedure, as routine surgical aortic valve replacement (AVR) requires that the breastbone be opened, and patients must be placed on a heart lung machine. Conversely, transapical AVI doesn’t involve opening the breastbone, nor does the procedure require utilization of the heart lung machine; hence the term “off-pump.”

So, why would a surgeon opt for transapical AVI, as opposed to transfemoral AVI? If a patient has too much calcium in their arteries or groin, this prevents us from being able to insert catheters in these areas, creating a case for transapical AVI.

Some of the typical candidates for this procedure include patients with severe aortic stenosis, or those who have blockage of the aortic valve. However, some patients do not qualify for this procedure, particularly for the purposes of the trial that Dr. Block mentioned in his last post. These include patients who are on dialysis, or who have had previous valve surgery. That said—we do anticipate that these parameters may change, potentially in late 2011.

Emory is truly a “one-stop-shop” in that we offer a multitude of services for the treatment of aortic stenosis: minimally invasive AVR, transcatheter AVI (transfemoral or transapical), off-pump left ventricle to descending aorta bypass, or balloon aortic valvuloplasty.  We are truly fortunate to be able to provide all of these services for our patients.

If you have any questions about transapical AVI or any of the numerous procedures we offer at Emory Heart & Vascular, please feel free to let me know in the comments section, or call me at 404-686-2513.

About Vinod H. Thourani, MD:

Dr. Thourani specializes in minimally invasive valve surgery (including mitral valve repair and replacement and aortic valve surgery) and transcatheter valve surgery (transfemoral and transapical aortic valve implantation).  He also performs other facets of adult cardiac surgery including on and off-pump coronary artery revascularization and atrial fibrillation surgery. He completed his general surgery residency, cardiothoracic residency, and cardiothoracic surgical research and clinical fellowships at Emory University.  Dr. Thourani joined Emory as a faculty member in 2005.

Transcatheter Valve Implantation Trial at Emory

The transcatheter heart valve is as large as 26 mm in diameter when expanded (left) and as small as 8 mm when collapsed over a balloon catheter (right).

In my last post, I focused on the definition, symptoms, diagnosis and treatment of aortic stenosis, a condition that can lead to heart failure. Sadly, aortic stenosis affects tens of thousands of Americans each year. In this post, I’d like to expand on one innovative treatment that is reducing the risks of this potentially fatal condition: transcatheter aortic valve implantation.

However, before we delve into an explanation of the treatment, let’s first review the specifics of the condition.

The aortic valve is the valve that connects the heart to the body, and is located between the left ventricle and the aorta. Blood flows through this valve, carrying oxygen to the rest of the body. There are typically three leaflets of tissue over the aortic valve that open and close and ensure proper blood flow. When the aortic valve becomes narrowed – either by degeneration or because is it abnormal from birth, the valve must be replaced to prevent heart failure.

Transcatheter aortic valve implantation is a new, innovative procedure used to replace the aortic valve. Rather than opening the chest and stopping the heart, we make a small incision in the groin or chest. We then insert a catheter (a thin, flexible tube) with a new aortic valve made of animal tissue through a blood vessel, using X-ray or ultrasound imaging to guide the device to the heart. As an alternative to open heart surgery, transcatheter aortic valve implantation has a substantially shorter recovery time and is particularly important for patients who are too weak to undergo the traditional process.

Emory has been involved in this groundbreaking technology since 2007, after Emory interventional cardiologist Vasilis Babaliaros, MD, helped bring the procedure back to us from France. The first cardiologist to perform transcatheter heart valve replacement was French doctor Alain Cribier, MD, who performed the procedure in 2002. Since 2007, we have completed approximately 85 transcatheter aortic valve implantations as part of a clinical trial, and we anticipate that the transcatheter valve will receive U.S. Food and Drug Administration (FDA) approval in late 2011. (You may view an animation video of the procedure here.)

Emory Heart & Vascular Center is proud to be one of the five largest centers in the United States and the most comprehensive in the Southeast to offer transcatheter aortic valve implantation. We are currently accepting patients for a new trial; for more information or to find out if you or someone you know may be a candidate for transcatheter aortic valve replacement, please contact me at 404-712-7667, or you may call Vinod Thourani, MD, at 404-686-2513. For other questions or comments on the procedure, I invite you to contribute in the comments section below.

What is Aortic Stenosis?

The word Aortic is derived from aorta, the main artery that pumps blood to the body from the heart. Additionally, the Greek translation of narrow is stenos.  In aortic stenosis, the aortic valve narrows, restricting blood flow from the heart to the body.

Most people are born with three leaflets of tissue over each artery that open and close as the heart beats. If someone is born with two leaflets, they may have premature narrowing of the valve. People with three valves often do not develop aortic stenosis until their 70s or 80s. Unfortunately, we can expect an increase in patients with aortic stenosis as baby boomers approach this age.

Common symptoms of aortic stenosis include:

–        Shortness of breath

–        Chest pain (often increasing with activity)

–        Fainting

–        Weakness

So, what is the science behind these symptoms? Simply put, as the aortic valve narrows, pressure increases inside the left heart ventricle. The left heart ventricle then becomes thicker, decreasing blood flow and causing chest pain. As the pressure continues to rise, blood may back up into the lungs, leading to shortness of breath. If you have a severe form of aortic stenosis, blood may not be able to reach your brain or other parts of your body as easily, causing fainting and weakness.

Typically, diagnosis starts with history-taking and a physical examination. We listen to the heart for a characteristic murmur that signifies a turbulent flow of blood across the narrow valve, and then perform an ultrasound to confirm the diagnosis.

For over 30 years, open heart surgery was the only way to treat aortic stenosis. Emory is the first hospital in the Southeast to study a non-surgical treatment called transcatheter aortic valve implantation.  It involves replacement of the narrow valve with a better-functioning synthetic valve from outside the body. We create a small incision in the groin or chest wall and then feed a wire mesh valve through a catheter, or tube, placing it where the new valve is needed. This technique may extend the lives of many people who are too ill or too frail to endure open-heart surgery.

In our next Heart and Vascular blog post, we’ll delve into more detail about procedures and technology surrounding aortic stenosis.

If you’re concerned that you may have aortic stenosis, we strongly encourage you to contact your physician for a physical. If you have further questions or comments regarding aortic stenosis or any other related condition, be sure to let me know in the comments section below.

Peter Block, MD has been practicing at Emory since 2000, where he specializes in internal medicine and cardiology. His areas of interests include angioplasty, cardiovascular disease, arteriosclerosis, and valve disease. Dr. Block’s major and/or recent publications focus on topics such as Equivalence Trials, Images in Clinical Medicine, and Short-Term Folic Acid Supplementation.