Aortic valve stenosis
Aortic valve stenosis — or aortic stenosis — occurs when the heart's aortic valve narrows. This narrowing prevents the valve from opening fully, which reduces or blocks blood flow from your heart into the main artery to your body (aorta) and onward to the rest of your body.
When the blood flow through the aortic valve is reduced or blocked, your heart needs to work harder to pump blood to your body. Eventually, this extra work limits the amount of blood it can pump, and this can cause symptoms as well as possibly weaken your heart muscle.
Your treatment depends on the severity of your condition. You may need surgery to repair or replace the valve. Left untreated, aortic valve stenosis can lead to serious heart problems.
Aortic valve stenosis ranges from mild to severe. Aortic valve stenosis signs and symptoms generally develop when narrowing of the valve is severe. Some people with aortic valve stenosis may not experience symptoms for many years. Signs and symptoms of aortic valve stenosis may include:
- Abnormal heart sound (heart murmur) heard through a stethoscope
- Chest pain (angina) or tightness with activity
- Feeling faint or dizzy or fainting with activity
- Shortness of breath, especially when you have been active
- Fatigue, especially during times of increased activity
- Heart palpitations — sensations of a rapid, fluttering heartbeat
- Not eating enough (mainly in children with aortic valve stenosis)
- Not gaining enough weight (mainly in children with aortic valve stenosis)
The heart-weakening effects of aortic valve stenosis may lead to heart failure. Heart failure signs and symptoms include fatigue, shortness of breath, and swollen ankles and feet.
When to see a doctor
If you have a heart murmur, your doctor may recommend that you visit a cardiologist. If you develop any symptoms that may suggest aortic valve stenosis, see your doctor.
Your heart has four valves that keep blood flowing in the correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps (cusps or leaflets) that open and close once during each heartbeat. Sometimes, the valves don't open or close properly, disrupting the blood flow through your heart and potentially impairing the ability to pump blood to your body.
In aortic valve stenosis, the aortic valve between the lower left heart chamber (left ventricle) and the main artery that delivers blood from the heart to the body (aorta) is narrowed (stenosis).
When the aortic valve is narrowed, the left ventricle has to work harder to pump a sufficient amount of blood into the aorta and onward to the rest of your body. This can cause the left ventricle to thicken and enlarge. Eventually the extra work of the heart can weaken the left ventricle and your heart overall, and it can ultimately lead to heart failure and other problems.
Aortic valve stenosis can occur due to many causes, including:
Congenital heart defect. The aortic valve consists of three tightly fitting, triangular-shaped flaps of tissue called cusps. Some children are born with an aortic valve that has only two (bicuspid) cusps instead of three. People may also be born with one (unicuspid) or four (quadricuspid) cusps, but these are rare.
This defect may not cause any problems until adulthood, at which time the valve may begin to narrow or leak and may need to be repaired or replaced.
Having a congenitally abnormal aortic valve requires regular evaluation by a doctor to watch for signs of valve problems. In most cases, doctors don't know why a heart valve fails to develop properly, so it isn't something you could have prevented.
Calcium buildup on the valve. With age, heart valves may accumulate deposits of calcium (aortic valve calcification). Calcium is a mineral found in your blood. As blood repeatedly flows over the aortic valve, deposits of calcium can build up on the valve's cusps. These calcium deposits aren't linked to taking calcium tablets or drinking calcium-fortified drinks.
These deposits may never cause any problems. However, in some people — particularly those with a congenitally abnormal aortic valve, such as a bicuspid aortic valve — calcium deposits result in stiffening of the cusps of the valve. This stiffening narrows the aortic valve and can occur at a younger age.
However, aortic valve stenosis that is related to increasing age and the buildup of calcium deposits on the aortic valve is most common in older people. It usually doesn't cause symptoms until ages 70 or 80.
Rheumatic fever. A complication of strep throat infection, rheumatic fever may result in scar tissue forming on the aortic valve. Scar tissue alone can narrow the aortic valve and lead to aortic valve stenosis. Scar tissue can also create a rough surface on which calcium deposits can collect, contributing to aortic valve stenosis later in life.
Rheumatic fever may damage more than one heart valve, and in more than one way. A damaged heart valve may not open fully or close fully — or both. While rheumatic fever is rare in the United States, some older adults had rheumatic fever as children.
Risk factors of aortic valve stenosis include:
- Older age
- Certain heart conditions present at birth (congenital heart disease) such as a bicuspid aortic valve
- History of infections that can affect the heart
- Having cardiovascular risk factors, such as diabetes, high cholesterol and high blood pressure
- Chronic kidney disease
- History of radiation therapy to the chest
Aortic valve stenosis can cause complications, including:
- Heart failure
- Blood clots
- Heart rhythm abnormalities (arrhythmias)
- Infections that affect the heart, such as endocarditis
Some possible ways to prevent aortic valve stenosis include:
- Taking steps to prevent rheumatic fever. You can do this by making sure you see your doctor when you have a sore throat. Untreated strep throat can develop into rheumatic fever. Fortunately, strep throat can usually be easily treated with antibiotics. Rheumatic fever is more common in children and young adults.
- Addressing risk factors for coronary artery disease. These include high blood pressure, obesity and high cholesterol levels. These factors may be linked to aortic valve stenosis, so it's a good idea to keep your weight, blood pressure and cholesterol levels under control if you have aortic valve stenosis.
- Taking care of your teeth and gums. There may be a link between infected gums (gingivitis) and infected heart tissue (endocarditis). Inflammation of heart tissue caused by infection can narrow arteries and aggravate aortic valve stenosis.
Once you know that you have aortic valve stenosis, your doctor may recommend that you limit strenuous activity to avoid overworking your heart.
To diagnose aortic valve stenosis, your doctor may review your signs and symptoms, discuss your medical history, and conduct a physical examination. Your doctor may listen to your heart with a stethoscope to determine if you have a heart murmur that may indicate an aortic valve condition. A doctor trained in heart disease (cardiologist) may evaluate you.
Your doctor may order several tests to diagnose your condition and determine the cause and severity of your condition. Tests may include:
Echocardiogram. This test uses sound waves to produce video images of your heart in motion. During this test, specialists hold a wandlike device (transducer) on your chest. Doctors may use this test to evaluate your heart chambers, the aortic valve and the blood flow through your heart. A doctor generally uses this test to diagnose your condition if he or she suspects you have a heart valve condition.
This test can help doctors closely look at the condition of the aortic valve, and the cause and severity of your condition. It can also help doctors determine if you have additional heart valve conditions.
Doctors may conduct another type of echocardiogram called a transesophageal echocardiogram to get a closer look at the aortic valve. In this test, a small transducer attached to the end of a tube is inserted down the tube leading from your mouth to your stomach (esophagus).
- Electrocardiogram (ECG). In this test, wires (electrodes) attached to pads on your skin measure the electrical activity of your heart. An ECG can detect enlarged chambers of your heart, heart disease and abnormal heart rhythms.
- Chest X-ray. A chest X-ray can help your doctor determine whether your heart is enlarged, which can occur in aortic valve stenosis. It can also show whether you have an enlarged blood vessel (aorta) leading from your heart or any calcium buildup on your aortic valve. A chest X-ray can also help doctors determine the condition of your lungs.
- Exercise tests or stress tests. Exercise tests help doctors see whether you have signs and symptoms of aortic valve disease during physical activity, and these tests can help determine the severity of your condition. If you are unable to exercise, medications that have similar effects as exercise on your heart may be used.
- Cardiac computerized tomography (CT) scan. A cardiac CT scan uses a series of X-rays to create detailed images of your heart and heart valves. Doctors may use this test to measure the size of your aorta and look at your aortic valve more closely.
- Cardiac MRI. A cardiac MRI uses magnetic fields and radio waves to create detailed images of your heart. This test may be used to determine the severity of your condition and evaluate the size of your aorta.
Cardiac catheterization. This test isn't often used to diagnose aortic valve disease, but it may be used if other tests aren't able to diagnose the condition or to determine its severity.
In this procedure, your doctor threads a thin tube (catheter) through a blood vessel in your arm or groin and guides it to an artery in your heart.
Doctors may inject a dye through the catheter, which helps your arteries become visible on an X-ray (coronary angiogram). This provides your doctor with a detailed picture of your heart arteries and how your heart functions. It can also measure the pressure inside your heart chambers.
Treatment for aortic valve stenosis depends on the severity of your condition, whether you're experiencing signs and symptoms, and if your condition is getting worse.
If your symptoms are mild or you aren't experiencing symptoms, your doctor may monitor your condition with regular follow-up appointments. Your doctor may recommend you make healthy lifestyle changes and take medications to treat symptoms or reduce the risk of complications.
You may eventually need surgery to repair or replace the diseased aortic valve. In some cases, your doctor may recommend surgery even if you aren't experiencing symptoms. If you're having another heart surgery, doctors may perform aortic valve surgery at the same time.
Surgery to repair or replace an aortic valve is usually performed through a cut (incision) in the chest. Less invasive approaches may be available, and your doctor will evaluate you to determine if you're a candidate for these procedures.
If you have aortic valve stenosis, consider being evaluated and treated at a medical center with a multidisciplinary team of cardiologists and other doctors and medical staff trained and experienced in evaluating and treating heart valve disease. This team can work closely with you to determine the most appropriate treatment for your condition.
Surgery options include:
Aortic valve repair
Surgeons rarely repair an aortic valve to treat aortic valve stenosis, and generally aortic valve stenosis requires aortic valve replacement. To repair an aortic valve, surgeons may separate valve flaps (cusps) that have fused.
Doctors may conduct a procedure using a long, thin tube (catheter) to repair a valve with a narrowed opening (aortic valve stenosis). In this procedure, called balloon valvuloplasty, a doctor inserts a catheter with a balloon on the tip into an artery in your arm or groin and guides it to the aortic valve. The doctor performing the procedure then inflates the balloon, which expands the opening of the valve. The balloon is then deflated, and the catheter and balloon are removed.
The procedure can treat aortic valve stenosis in infants and children. However, the valve tends to narrow again in adults who've had the procedure, so it's usually only performed in adults who are too ill for surgery or who are waiting for a valve replacement, as they typically need additional procedures to treat the narrowed valve over time.
Aortic valve replacement
Aortic valve replacement is often needed to treat aortic valve stenosis. In aortic valve replacement, your surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).
Biological tissue valves degenerate over time and may eventually need to be replaced. People with mechanical valves will need to take blood-thinning medications for life to prevent blood clots. Your doctor will discuss with you the benefits and risks of each type of valve and discuss which valve may be appropriate for you.
Doctors may perform a less invasive procedure called transcatheter aortic valve replacement (TAVR) to replace a narrowed aortic valve. TAVR may be an option for people who are considered to be at intermediate or high risk of complications from surgical aortic valve replacement.
In TAVR, doctors insert a catheter in your leg or chest and guide it to your heart. A replacement valve is then inserted through the catheter and guided to your heart. A balloon may expand the valve, or some valves can self-expand. When the valve is implanted, doctors remove the catheter from your blood vessel.
Doctors may also conduct a catheter procedure to insert a replacement valve into a failing biological tissue valve that is no longer working properly. Other catheter procedures to repair or replace aortic valves continue to be researched.
Lifestyle and home remedies
You'll have regular follow-up appointments with your doctor to monitor your condition. You'll need to continue taking all your medications as prescribed.
Your doctor may suggest you incorporate several heart-healthy lifestyle changes into your life, including:
- Eating a heart-healthy diet. Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish, and whole grains. Avoid saturated and trans fat, and excess salt and sugar.
- Maintaining a healthy weight. Aim to keep a healthy weight. If you're overweight or obese, your doctor may recommend that you lose weight.
- Getting regular physical activity. Aim to include about 30 minutes of physical activity, such as brisk walks, into your daily fitness routine.
- Managing stress. Find ways to help manage your stress, such as through relaxation activities, meditation, physical activity, and spending time with family and friends.
- Avoiding tobacco. If you smoke, quit. Ask your doctor about resources to help you quit smoking. Joining a support group may be helpful.
For women with aortic valve stenosis, it's important to talk with your doctor before you become pregnant. Your doctor can discuss with you which medications you can safely take, and whether you may need a procedure to treat your valve condition prior to pregnancy.
You'll likely require close monitoring by your doctor during pregnancy. Doctors may recommend that women with severe valve stenosis avoid pregnancy to avoid the risk of complications.
Preparing for an appointment
If you think you have aortic valve stenosis, make an appointment to see your doctor. Here's some information to help you prepare for your appointment.
What you can do
- Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do beforehand.
- Write down your symptoms, including any that seem unrelated to heart valve disease.
- Write down key personal information, including a family history of heart disease, and any major stresses or recent life changes.
- Make a list of all medications, vitamins and supplements you take.
- Take a family member or friend along, if possible. Someone who accompanies you can help you remember information you receive.
- Be prepared to discuss your diet and exercise habits. If you don't already eat well and exercise, be ready to talk to your doctor about challenges you might face in getting started.
- Write down questions to ask your doctor.
For aortic valve stenosis, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- What are other possible causes for my symptoms or condition?
- What tests will I need?
- What's the best treatment?
- What are the alternatives to the primary approach you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there restrictions I need to follow?
- Should I see a specialist?
- If I need surgery, which surgeon do you recommend for heart valve surgery?
- Is there a generic alternative to the medicine you're prescribing?
- Are there brochures or other printed material I can take with me? What websites do you recommend?
Don't hesitate to ask other questions you have.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:
- When did your symptoms begin?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?