Physician: Congenital Aortic Stenosis Is A Rare Ailment
A. Vincent Songco
The Lenawee County Medical Examiner’s Office ruled that Jasmin Torres died of congenital aortic stenosis, a rare disorder found in only about 5 percent of patients who are diagnosed with congenital heart disease.
Dr. A. Vincent Songco, an adult interventional cardiologist with ProMedica Physicians Cardiology, did not treat Jasmin nor is he familiar with her case. He was asked by The Monroe News to explain congenital aortic stenosis and what might occur in a hypothetical situation.
Aortic stenosis, Songco said, can be treated if detected. However, if severe aortic stenosis is undetected, sudden death can occur. He added that sudden death also has been associated with strenuous exercise.
“The stenosis severity can range from mild to severe and it is rarely fatal,” Songco said in an email. “It is typically detected on physical exams due to the presence of a murmur.”
Songco explained that the aortic valve normally is made up of three thin leaflets that close tightly when the main pumping chamber (left ventricle) is filling with blood. The leaflets then open widely when the heart pumps or beats, pushing all the oxygenated blood through the aortic valve to the entire body.
Congenital aortic stenosis occurs when the valve is narrowed severely. When the valve narrows, this limits the amount of oxygenated blood reaching the body.
The disease is typically progressive and treatment typically is done when the stenosis is severe and the patient is experiencing symptoms. This is done most often with either a surgical valve repair or a valve replacement.
A murmur, he said, is the sound of turbulent blood flow through narrowed valves. Even mild aortic stenosis can cause a murmur. Typically, this can lead to an echocardiogram that would normally confirm the diagnosis.
Most patients with untreated symptomatic aortic stenosis die from congestive heart failure. Others suffer sudden cardiac death. The exact mechanism of sudden death is unclear, but it is hypothesized that there is either sudden poor cardiac output leading to circulatory failure or a fatal arrhythmia.
Sandra Torres said her daughter never showed any symptoms of stress or obvious excess fatigue. She said she was never found to have a heart murmur. She said there were other issues with her daughter’s heart, such as all three coronary arteries being on one side of the heart, which is abnormal. That could have contributed to Jasmin’s death.
Rick Carsten, superintendent of Ida Public Schools, said all students are required to have a physical and Jasmin successfully had one completed before she was allowed to compete. He said the district keeps a close eye on students with known ailments, such as asthma or diabetes, when they compete.
The current recommendations for screening athletes for congenital heart disease comes from the American Heart Association and consists of obtaining a thorough personal and family history and preforming a full physical exam. An EKG and an echo are not recommended as part of the standard screening process. They are done if there are any concerning historical or physical exam findings.
Torres said there is no real history of heart disease in the family. After Jasmin died, she had an EKG done on her children. None appeared to have any issues.
Story Credit: http://www.monroenews.com/news/20170710/physician-congenital-aortic--stenosis-is-rare-ailment
