Asked by Bruce, Coral Springs, Florida
Can an 87-year-old woman with aortic stenosis travel on a jet without complications?
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
The heart is really two muscular pumps with valves to make sure blood flows in the correct direction. The right side of the heart receives blood from throughout the body and pumps blood to the lungs and the left side receives oxygenated blood from the lungs and pumps it to the entire body. The left side is a bigger and stronger muscle as it must pump to a larger area.
The ventricle, or big pumping chamber on left side, has two valves. Blood enters the left ventricle through the mitral valve and leaves through the aortic valve. A stenotic valve is a valve opening that has gotten smaller and is partially obstructing blood flow. In the case of this question, the aortic valve.
A patient can be born with stenosis of the aortic valve (AS). One can also develop it because of rheumatic heart disease resulting from a strep infection. Most commonly, especially in older people, one can develop AS over time because of high cholesterol. Cholesterol buildup and the thickening of the valve decrease the valve opening's size, and it becomes calcified.
The size of the valve opening is critical to its function. Size is measured with an echogram (an ultrasound imaging the heart). The normal aortic valve opening is about 3.0 to 4.0 square cm in adults. When the valve opening slowly narrows over time, the heart adapts or accommodates. The heart wall strengthens and thickens to keep blood flow normal. Pressures within the heart go up but blood flow out of the heart remains normal until the opening is about half of normal size.
The patient with AS can be asymptomatic for a long time despite severe obstruction. The classic first symptoms associated with AS typically occur with exertion. They are decreased exercise tolerance, shortness of breath and fatigue -- all symptoms of chronic heart failure -- as well as dizziness, fainting, and chest pain.
Once symptoms develop, even if they are mild, the AS is considered severe. Prompt surgical intervention and replacement of the valve is the preferred therapy. The average survival of someone with symptomatic AS without valve replacement is only two to three years, with a high risk of sudden death from cardiac rhythm disturbances. Up to a third of patients with symptomatic aortic stenosis suffer sudden cardiac death.
Some patients with asymptomatic but fast-progressing AS should also get valve replacement. Surgery in such patients generally helps keep the symptoms from progressing and reduces the risk of death. Patients with AS who are not candidates for surgery require careful monitoring and treatment by a cardiologist.
Your concerns about air travel are well founded. Airplanes are generally pressurized to an altitude of 8,000 to 10,000 feet. This means air is thinner, and some patients might benefit from supplemental oxygen.
In general, a patient with diagnosed aortic stenosis that is asymptomatic with exercise can safely fly on an airplane. A physician should see such a patient and give medical clearance.
In some circumstances, patients with mild symptoms who are awaiting surgery or who are not candidates for surgery may still be able to travel. All airlines have physician consultants and this might require the patient's physician talking directly with the airline's physician.
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