Q: for the past five years, I have known I have aortic stenosis. I have no symptoms. Will I have a shortened life? I’m 55.

A: Stenosis indicates narrowing. The aortic valve closes when the heart pumps blood out and into the aorta and the entire body.

Closure of the valve stops blood from leaking back into the heart. Because the valve and its opening have constricted, the heart has to pump harder to empty itself. that strains the heart, and, in time, leads to heart failure.

The danger and consequences of stenosis depend on how narrow the opening and valve are. Doctors can get an accurate picture of the valve’s dimensions with an echocardiogram.

When the valve and its opening reach a critical size, decisions need to be made about the best treatment. often, it’s surgery with the installation of an artificial valve.

If a severely narrowed valve goes untreated, three symptoms develop: chest pain on activity (angina), shortness of breath and fainting spells.

Death occurs within three or fewer years unless a new valve is put in place. Surgery is usually performed well before these signs make their appearance. you might never need a correction if the narrowing process stops.

You probably wonder how you acquired the valve problem. you might have been born with a valve that had minor defects, which promoted narrowing. Calcifications could have settled on the valve. or you might have had rheumatic fever as a child, which caused valve deformity.

Q: I have had three attacks of gallbladder pain because of gallstones.

My doctor is pushing me to have my gallbladder removed. The prospect of surgery doesn’t thrill me.

How does my body function without a gallbladder?

A: have the surgery. you have had three attacks of gallbladder pain; you’re bound to have more. you won’t find the surgery as frightening as you imagine. often, it is done through small incisions with the guidance of a scope.

The body does quite well without a gallbladder. It’s a reservoir for bile, which is made in the liver. When a person eats a meal that has fat in it, as most meals do, the gallbladder contracts, sending a jet of bile into the digestive tract to promote fat digestion.

Without a gallbladder for storage, bile drips into the digestive tract on a constant basis; that works out well.

Medicines can dissolve gallstones. they take a long time to work, and the stones have to be small. Frequently, the stones re-form after medicines are stopped.

Dr. Donohue answers letters only in his North America Syndicate column but provides an order form of available health newsletters. Write him at P.O. Box 536475, Orlando, FL 32853-6475.

MANILA, Philippines – an aneurysm is a permanent distention of an artery caused by a weakness in its wall. Aneurysm can form anywhere, but the most common and problematic sites are the arteries of the brain, and the aorta, the large major artery through which the heart pumps blood to the rest of the body.

There are three basic reasons why an aneurysm might develop in one of your arteries:

There are three layers of tissue in your arterial walls. The muscular middle layer supplies the supportive strength of your arteries, and this layer may be congenitally defective (from birth). The normal pressure of the blood in the affected artery causes a balloon like swelling, which is called a saccular aneurysm. Aneurysms resulting from congenital defects are almost always found in arteries at the base of the brain and it is called berry aneurysm because of their shape and they are usually clustered together.

Inflammation, whatever the cause, may weaken an arterial wall. most arterial inflammation is caused by disorders such as polyarteritis nodosa, syphilis, bacterial endocarditis, or inflammatory disease of unknown origin called aortitis.

A portion of the muscular middle layer of the arterial wall slowly degenerates as the result of aging, chronic condition such as arteriosclerosis (hardening of the arteries) or atherosclerosis (a type of arteriosclerosis when cholesterol infiltrates the lining of the blood vessels), and degeneration may be accelerated by high blood pressure. Aneurysm caused by arteriosclerosis is likely to be a sausage-shaped swelling called fusiform aneurysm. Hypertension can accelerate arteriosclerosis and is frequently associated with the formation of aneurysms. Increased pressure of blood in an artery, however, can stretch the wall in many ways. It can even split the layers of the artery and force blood between them. this is called a dissecting aneurysm.

An aneurysm can burst, which leads to hemorrhage, or internal bleeding, at the site of the aneurysm and to loss of blood supply to certain tissues. an aneurysm can swell so much that it presses on and damage neighboring organs, nerves, or other blood vessels. It can also disturb the flow of blood to such an extent that its turbulence causes dangerous clots to form.

What are the symptoms?

The symptoms of aneurysm vary according to the type, size, and location of the swelling. if the aneurysm is at the arteries of the brain, usually cause no obvious symptoms until it burst. a sudden severe headache at the back of your head, or even unconsciousness, may be the first sign of this aneurysm.

If you have aneurysm of the aorta, your symptoms will depend on these factors: what portion of the aorta is affected, what structures the aneurysm presses on, and what type of aneurysm you have. if the portion of the artery that passes through your chest is affected, symptoms include chest pain, hoarseness, difficulty in swallowing, and persistent cough that is not helped by cough medicine.

If the aneurysm is located toward your back, it may press on the bones of your spine and cause backache, especially if it is expanding or rupturing.

What are the risks?

The major risk of an aneurysm is that it may burst and cause hemorrhage, allowing blood to flow into the surrounding area, and depriving tissues of oxygen and nutrients. The entire circulatory system may collapse if the leak drastically reduces the volume of blood. without immediate medical help, a burst aneurysm is fatal.

Even when it does not burst, an aneurysm of the aorta causes turbulence in the flow of blood that can cause the formation of a thrombus, or clot, with all the associated dangers. Emboli, which are parts of a blood clot that breaks away from the thrombus, can block smaller arteries such as those that supply the kidneys or other organs, and this can lead to a permanent damage to these organs.

What should be done?

Long before aneurysm causes symptoms, it may be detected by an ultrasound examination, or confirmed by ultrasound if your physician has found it during a physical examination. a small aneurysm may not require treatment. if you are in good physical condition, an elective operation on a large aneurysm or one that is increasing in size carries far less risk than an operation done as an emergency when the aneurysm has leaked or ruptured.

What is the treatment?

Self-help: The best ways to prevent aneurysms are to take steps to prevent or slow down atherosclerosis and, if you have high blood pressure, to keep it under control.

Professional help: Surgery is the usual treatment for aneurysm.