“Aortic valve stenosis” is an often-overlooked condition and a growing health concern in ageing societies such as Thailand. With an increasing elderly population and a rise in age-related valve degeneration, this condition poses a serious threat to public health. According to the Ministry of Public Health’s 2022 report, cardiovascular diseases claimed 70,000 Thai lives — equivalent to eight deaths every hour. Among these, heart valve disease is a key contributor, particularly aortic valve stenosis, which is increasingly prevalent among individuals aged 65 and older. As people age, calcium deposits can cause the aortic valve to thicken and stiffen, reducing its ability to open fully and thus restricting blood flow.
To raise awareness of this condition, February 22nd is observed annually as Heart Valve Disease Awareness Day, a global initiative aimed at educating the public, promoting early diagnosis, and encouraging timely and effective treatment. Improving public understanding of the disease can significantly reduce mortality and morbidity associated with heart valve disease.
Asst. Prof. Dr. Chanapong Kittayarak, a specialist in cardiothoracic surgery from the Division of Thoracic Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University
Asst. Prof. Dr Chanapong Kittayarak, cardiothoracic surgery specialist at the Division of Thoracic Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, explains that aortic valve stenosis occurs when the valve regulating blood flow from the left ventricle to the aorta becomes narrowed. This narrowing forces the heart to work harder, reducing blood supply to the rest of the body. Symptoms include fatigue, dizziness, fainting, chest pain, palpitations, swollen ankles, and irregular heartbeats. If left untreated, the condition can lead to severe complications such as heart failure, arrhythmias, sudden cardiac arrest — or death.
Unfortunately, many patients remain unaware due to the similarity of symptoms with other conditions such as lung disease, coronary artery disease, diabetes, hypertension, or obesity. Many dismiss signs like breathlessness and fatigue as part of ageing, work-related exhaustion, or stress — delaying diagnosis and treatment. This highlights the importance of awareness and early detection.
Screening and Diagnosis
Diagnosis of aortic valve stenosis begins with physical examination and heart auscultation. Further assessments may include chest X-rays, electrocardiograms (ECG), echocardiography, MRI, or CT scans to determine disease severity. Treatment for moderate to severe cases depends on the condition’s progression. Severe cases may require surgical aortic valve replacement (SAVR) via open-heart surgery. The surgical team at Chulalongkorn University has over 40 years of experience in both standard sternotomy and minimally invasive cardiac surgery.
For high-risk patients or those unsuitable for open-heart surgery, transcatheter aortic valve replacement (TAVR) — a less invasive procedure — is a viable alternative.
Two Main Valve Replacement Options
1.Mechanical Valves – Made from carbon or titanium, mechanical valves are extremely durable and may last a lifetime. However, patients must take lifelong anticoagulant medications to prevent blood clot formation, including regular INR (International Normalised Ratio) blood tests and a consistent intake of vitamin K. High-risk activities like rock climbing or mountain biking should be avoided due to the risk of bleeding. For women of childbearing age, mechanical valves pose additional challenges, as anticoagulants like warfarin can harm both mother and foetus, increasing risks of congenital abnormalities, miscarriage, and peripartum bleeding.
The Function of the Four Chambers of the Heart
2.Tissue Valves – Bioprosthetic valves, made from bovine or porcine tissue, are less durable but typically do not require long-term anticoagulation therapy. This makes them preferable for women planning pregnancy, individuals with limited access to healthcare, and those engaged in high-risk occupations or lifestyles. Although these valves may eventually require re-replacement, medical advances are improving their durability and performance.
Shared Decision-Making
Asst. Prof. Dr. Chanapong Kittayarak, a specialist in cardiothoracic surgery from the Division of Thoracic Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University
Dr Chanapong highlights that treatment decisions follow a shared decision-making approach, based on guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA). Physicians assess the patient’s overall health, age, disease severity, and anatomical suitability for each treatment option. Post-surgery, patients undergo personalised cardiac rehabilitation, helping them resume daily life and improve their quality of life.
