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[Kuala Lumpur]

Does the heart also have a door? That’s right! The human heart valve is like the door and window of the heart. Each valve must operate smoothly to make blood run smoothly, while the aortic valve is like the “gate” of the heart. Only when the gate opens and closes smoothly, the heart can supply blood effectively.  Once the valve is narrow or unable to close, the heart will be underpowered, and in severe cases, it may even lead to heart failure.

In recent years, the incidence of heart valve disease has been significantly increasing among the elderly, especially those at high risk after the age of 70. Aortic valve stenosis is a common type of valvular disease in the elderly age.

Many people may be unfamiliar with the term “aortic valve stenosis”, but do you still remember Serena Liu, the queen of Taiwan’s national standard dance, who passed away not long ago? The culprit that took her precious life was aortic valve stenosis. How dangerous is aortic valve stenosis? Let the CVSKL Cardiologist tell you the truth!

Dr Choo Gim Hooi, a cardiologist at the Cardiac Vascular Sentral of Kuala Lumpur (CVSKL), believes that aging should not be a reason for patients to refuse treatment. With correct treatment measures, elderly patients can also maintain the quality of life and live a wonderful life.

Dr Choo Gim Hooi: There are two types of aortic valve stenosis

Dr. Choo Gim Hooi, a cardiologist at Cardiac Vascular Sentral Kuala Lumpur (CVSKL), pointed out that aortic valve stenosis can be divided into two categories. One is caused by degenerative, calcified or infection. Elderly people are prone to valve calcification, valve thickening and hardening, deformation of calcium salt deposition, etc. Such lesions generally lead to valve stenosis or incomplete atresia, causing blood backflow problems.

Congenital valve disease is another type of causes: “Once aortic valve stenosis is diagnosed, treatment should be taken as soon as possible to avoid affecting the quality of life, and it also improve the survival rate of the patients.”

Cardiologist at the Cardiac Vascular Sentral Kuala Lumpur (CVSKL) Datuk Dr Rosli is the Malaysia’s first transcatheter aortic valve implantation supervisor (Proctor). He emphasized that not all patients with aortic valve stenosis need immediate surgery. Doctor will first assess the patient’s valve damage and then formulate a best appropriate treatment plan to the patient.

Datuk Dr Rosli: Degenerative diseases are major affected by the age.

Cardiac Vascular Sentral Kuala Lumpur (CVSKL) cardiologist Datuk Dr. Rosli Mohd Ali said that aortic valve stenosis is a degenerative disease that will change over time. The patient may not have any obvious symptoms in the early stage of aortic valve stenosis. Once symptoms appear, the aortic valve stenosis is considering a serious condition. This condition usually will worsen within 2 – 3 years period. Repair and replaced aortic valve are the best option treatment for the aortic valve stenosis patient.

Of course, not all aortic valve stenosis requires immediate surgery. The doctor will assess the patient’s valve damage and the nature of the disease before deciding whether to repair or replace the valve: “Patients with mild symptoms generally do not need surgery, but they need regular follow-up visits. In order to monitor whether the heart valve is further narrowed and determine the appropriate time for surgery. Patients with severe aortic stenosis must undergo surgery. Adult and elderly people should also receive regular heart-related examinations every year to get as early as possible find out heart problems and treat them promptly.”

The incidence of aortic valve stenosis is more common in the elderly, but young people may also suffer from aortic valve stenosis (Serena Liu is an example), but the incidence of young people is much lower than that of elderly people over 65.

Morbidity is more common in the elderly

Dr. Datuk Rosli and Dr. Choo Gim Hooi said that the incidence of aortic valve stenosis is more common in the elderly (especially those over 65). Therefore, it is often seen in outpatient clinics that the elderly do not want to spend money to treat the aortic valve. If you are narrow, or worry that the medical expenses may not be effectively treated, you would rather give up treatment. In addition, there are also many patients who give up treatment mainly because they are too old to undergo traditional open-heart surgery and cannot wait for a heart transplant. However, if aortic valve stenosis is not treated, these elderly patients with aortic valve stenosis will often suffer various symptoms, such as chest tightness, asthma, poor mobility, inability to lie down, painful, with poor quality of life.

Actually, you may not know? With the advancement and development of medicine, in addition to traditional open heart-surgery for aortic valve stenosis, Transcatheter Aortic Valve Implantation/Replacement (TAVI or TAVR) can also be used for Minimally Invasive Aortic Valve Replacement Surgery. This type of surgery is usually can performed by a cardiologist.

Dr. Datuk Rosli said that the emergence of this micro-innovative technology has brought new hope to eldery patient which not suitable for open heart surgery to replacement the aortic valve: “Even the elderly can recover as long as they receive treatment by extend their life, and regain a normal life. Therefore, we should get rid of the inertial thinking that elderly patients do not need treatment, especially today with the continuous development of medical technology, the emergence of transcatheter aortic valve implantation makes many patients do not need surgery A thoracotomy can also replace the main valve.”

Dr. Datuk Rosli is also Malaysia’s first Transcatheter Aortic Valve Implantation (TAVI) Supervising Doctor (Proctor). He is responsible for training and supervising the application and operation of the TAVI program to others doctor, and help to train the doctors to be fully prepared for any form of operation.

Transcatheter Aortic Valve Implantation (TAVI)

Since there is no medicine to treat aortic valve stenosis, through valve repair or replacement surgery is the only way to relieve symptoms and prolong life. Generally, the traditional open-heart surgery aortic valve replacement (Surgical Aortic Valve Replacement, SAVR) requires opening the heart to remove the damaged valve and then implanting it into a new artificial aortic valve (biological valve or mechanical valve can be used), but open-heart surgical operation is a risky surgery and It may not be suitable for all patients. This is because most patients with severe aortic stenosis are elderly age, and often have other disease at the same time (for example: heart, lung & kidney function is weak).

TAVI is a new minimally invasive technique in which a biological valve is implanted in the diseased valve by a percutaneous catheter. Suitable for elderly patients which suffering from severe aortic stenosis. The doctor will pierce the skin in the groin, upper leg arteries, carotid arteries, the space between the ribs and other suitable “channels”, insert the catheter into the artery, pass the blood vessel directly into the heart, and then directly replace the aortic valve in the heart by the catheter valve. The difference between TAVI and open-heart surgery is that no need to open the patient’s chest and avoid stop the heartbeat to implant the artificial valve. The artificial valve is directly implanted/replaced while the patient’s heart is still beating. This procedure can be done under local anaesthesia or sedatives.

This new technology has the characteristics of less trauma and quick recovery, it is an ideal treatment plan for certain patient populations (for example: patients with severe aortic stenosis but unable to accept surgery, high-risk groups of surgery, etc.). Of course, TAVI is not zero risk, but it is relatively lower than open heart surgery. It is recommended to discuss with your attending doctor to customize a suitable treatment plan.

Warning Signs of Aortic Valve Problems

■ Feel Chest pain and pressure

■ Feel weak.

■ Dizziness

■ Feeling tired

■Shortness of breath

■Heart palpitations or feeling the heart beating irregularly

■Heart murmur

Understanding Aortic Stenosis

The artery is located in the left ventricle of the heart. It is a conduit for blood from the heart to the body. The aortic valve is the door that opens the passage. With age, the opening of the aortic valve may gradually narrow. Aortic valve stenosis refers to the obstruction of blood flow through the aortic valve. This is a progressive disease. Common clinical symptoms include decreased exercise capacity, exertional chest pain (angina), syncope, and heart failure. Patients suffering from aortic stenosis may die within a few years if they don’t receive the correct treatment.

Cardiologists can understand and master the health of the aortic valve through various examinations, including: cardiac ultrasound/echocardiogram (measures the thickness, relaxation, and prolapse of the valve, and can also assess the contractile function of the left ventricular muscle, whether the atria and ventricles are enlarged, etc.), electrocardiogram (such as checking whether the left atrium and left ventricle are hypertrophy), physical examination (such as: the doctor finds that the patient’s heart has a murmur during auscultation), carotid ultrasound examination, CT Scan and etc. The doctor will decide which tests are needed based on the individual patient’s condition.



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