When the aortic valve does not open properly, the heart has to work harder to pump blood.

The aortic valve is the final “door” the blood goes through as it leaves the heart’s left ventricle (main pump) en route to the aorta (main artery bringing blood throughout the body). When aortic valve stenosis is present, the aortic valve becomes very narrow and does not open properly. The left ventricle must then work harder than normal to pump blood throughout the body.

If you have aortic stenosis, replacing the diseased aortic valve is the best option. Aortic stenosis is not curable with medical therapy alone. If untreated, aortic stenosis can cause the left ventricle to weaken and fluid to back up in the lungs causing congestive heart failure. Most patients recover well after having an aortic valve replacement.

Congenital aortic stenosis is a congenital heart defect involving the aortic valve (e.g., instead of having the normal three flaps, the valve only has one or two) that results in an incomplete opening of the valve, making it more difficult for the heart to pump blood to the body. Management depends on age at diagnosis, severity of the obstruction and symptoms. In children, treatment may include balloon or surgical valvotomy.

Causes

Aortic valve stenosis is most commonly caused by aging processes. Over time, as the blood is ejected forcefully by the left ventricle into the aorta, the thin leaflets (doors) of the aortic valve can get damaged. When the leaflets are damaged, scarring occurs and calcium deposits on the leaflets restricting their movement and causing narrowing of the valve opening.

Aortic valve stenosis can also be caused by congenital heart defects, including deformities such as bicuspid aortic valve. In this condition, the valve has two flaps rather than the normal three.

Symptoms

Symptoms can include:

  • Difficulty catching your breath
  • Fatigue
  • Dizziness or lightheadedness
  • Chest pain
  • Swelling in the legs or feet
  • Fainting with exertion

Diagnosis

Often heart valve disease is diagnosed when a physician hears abnormal sounds (heart murmur) through a stethoscope. Diagnostic tests to specify the valve disease include:

  • Electrocardiogram (EKG/ECG) – A test that records the electrical activity of the heart
  • Chest X-ray – A radiograph or picture of the heart and lungs including blood vessels, ribs and bones of the spine
  • Transesophageal echocardiogram (TEE) – A test to provide an image of heart structures; a small transducer (like a microphone) is passed down the esophagus to produce the image
  • Echocardiogram (also called echo) – This test uses sound waves to assess the function and structure of the heart muscle and valves
  • Cardiac catheterization – A procedure to check for problems in coronary arteries. A long, thin tube (catheter) is inserted into an artery or vein in the groin, arm or neck, then threaded to the heart. The physician injects a contrast solution into the artery and takes X-rays to check for blockage and other abnormalities.
  • Exercise stress test – A test performed on a treadmill or stationary bicycle to measure heart, lung and muscle function during physical activity. You are attached to an electrocardiogram (EKG/ECG) to record electrical activity of the heart.

Treatments

Surgery and other procedures

A procedure to repair or to replace the defective valve with an artificial valve may be necessary. There are currently two procedures that replace defective aortic valves: surgical aortic valve replacement or transcatheter aortic valve replacement. Early aortic valve replacement usually improves symptoms and can help prevent damage to the heart that can occur if the stenosis is not treated.

Balloon valvuloplasty is another less invasive procedure that may be appropriate for aortic valve stenosis when surgery is not an option.

Medications

Some people who have aortic valve regurgitation or stenosis have few or no symptoms, but if you are diagnosed with these conditions, you should be monitored by your physician. Medication may be necessary to treat the symptoms at a certain point. 

Advancing Care for Structural Heart Disease at Ohio State

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