The aortic valve lets oxygenated blood flow from your heart into the aorta, which then carries the blood to your body. A narrowing of the aortic valve can cause heart failure.
A narrowing may be caused by age, or a congenital defect such as Turner syndrome (with two cusps instead of three). Surgery to repair or replace the valve is often recommended.
Symptoms
The aortic valve is the last of the four heart valves that blood passes through before it exits your heart into the aorta, your body’s main blood vessel. During ventricular systole (the heartbeat-emptying phase), the aortic valve opens to let oxygen-rich blood flow into the aorta. As the pressure drops after systole ends, the aortic valve closes. If the aortic valve doesn’t open properly, the blood can build up in the heart or back up into the lungs. Then your heart has to work harder to pump the blood through the body. This can cause symptoms such as chest pain, shortness of breath or fainting spells.
Age: Over time, calcium deposits can form on the aortic valve, stiffening it and limiting its function. This happens more often as people get older. It can also happen because of other health problems, such as high blood pressure or rheumatic fever, which is a complication of strep throat. Other diseases: Rheumatoid arthritis and other inflammatory disorders can damage the valve. Infectious endocarditis, a serious bacterial infection of the heart valves that can be caused by a viral or bacterial infection such as strep throat, can also cause damage to the aortic valve.
Some children are born with an abnormal aortic valve. If the problem is severe, they may need surgery before becoming adults.
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Diagnosing aortic valve disease starts with a health assessment, review of your medical history and physical exam. Your doctor listens to your heart with a stethoscope for a whooshing sound (murmur) that can signal valve trouble. Other tests include a cardiac computerized tomography scan, a chest X-ray and a heart catheterization. During this test, your doctor inserts a thin tube into a blood vessel in your arm or groin and guides it to the heart. A special dye and X-rays show your heart valves, including the aortic valve.
If your aortic valve is damaged, you can manage the condition with medicines that control blood pressure and prevent clots. You may need to avoid strenuous activity, take regular echocardiograms and have your doctor monitor symptoms for progression.
Diagnosis
Your doctor diagnoses aortic valve disease by asking about your symptoms, doing a physical exam, and running diagnostic tests. They may also use a stethoscope to hear a heart murmur or click sound. If your symptoms are severe, they may ask you to do an echocardiogram (ultrasound of the heart). This test measures how well your aortic valve opens and closes. It also shows how much fluid is building up in your body due to leaky heart valves.
Your aortic valve can become damaged by normal wear and tear, or from infections that damage the heart tissue and blood vessels surrounding it. Most people with aortic stenosis have had it for years before they notice any symptoms. The condition can be caused by rheumatic fever, which usually develops after strep throat or scarlet fever. Rheumatic fever can cause permanent damage to your heart’s valves and affect the blood flow through them. Other causes of aortic stenosis include aging, infection, and calcium build-up.
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When symptoms are mild, you may be treated with medicine. These medicines can help your heart work more efficiently, reduce the amount of fluid build-up in your body, and relieve your symptoms. You may also need to limit your activity level and avoid strenuous exercise.
For more severe aortic stenosis, surgery may be needed. Your healthcare team can help you decide whether to have a surgical procedure that repairs or replaces your aortic valve. This surgery is done with anesthesia. You’ll sleep through most of the operation, and you won’t remember it afterward.
Before the surgery, you’ll need to stop smoking and take blood thinners. Your doctor may also recommend other lifestyle changes. We have a wide range of specialists who can work with you to make these changes.
We have several options for your surgery, including TAVR, a minimally invasive procedure that uses a catheter to insert a replacement valve inside your aortic valve. We also offer open surgery, in which your surgeon makes an incision down the middle of your chest. During this procedure, you’ll be connected to a heart-lung machine that acts as your heart and lungs during the operation.
Treatment
Today, there are more options than ever to treat aortic valve disease. Your healthcare team will help you choose the best treatment for you. Surgery to repair or replace the valve is often recommended. Surgery can help relieve symptoms, improve your day-to-day quality of life and extend your lifespan. In severe cases, aortic stenosis can cause heart failure or even be fatal.
A health care professional can diagnose aortic valvular disease with a physical exam and review of your symptoms and medical history. They will listen to your heart with a stethoscope for a whooshing sound (murmur). An echocardiogram is an imaging test that creates pictures of your heart and valves. This test may also show if you have calcium buildup on your aortic valve.
Another test, a cardiac magnetic resonance imaging (MRI), uses radio waves and magnets to create detailed images of your heart and its structure without using radiation. This test can detect if your aortic valve is narrowing because of calcium deposits or if you have scar tissue from rheumatic fever.
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Some people with aortic valvular disease have a genetic mutation that causes the aortic valve to grow too slowly. This condition, called bicuspid aortic valve (AVV), is most common in adults over 65. It can also result from rheumatic fever, which is a common childhood illness that damages the aortic valve and leads to aortic stenosis in adulthood.
Surgery to replace a damaged aortic valve is called aortic valve replacement. You can have this operation either to treat aortic stenosis or to reduce the risk of death from other problems, such as heart failure. The type of surgery you have depends on how severe your aortic stenosis is, how much risk you face from blood clots and other complications and whether you have other conditions that put you at high risk for open-heart surgery.
You may need a mechanical valve made of man-made materials, such as titanium or carbon, or a biological valve made of human or animal tissue. Depending on the kind of valve you have, you will need to take blood-thinning medicines to guard against blood clots for the rest of your life.
Preventive measures
While some people are born with a defective aortic valve, most develop heart valve disease over time. The aortic valve’s job is to let oxygen-rich blood leave your heart and enter the aorta, the body’s largest blood vessel. This is a very important function, but over the years, your valve may go through a process similar to that of atherosclerosis (clogging of arteries with plaque): lipids like cholesterol build up, inflammation occurs, and calcium collects in the soft tissues of the valve. Over time, this can cause the valve to become stiffer and narrower. This is a condition called aortic stenosis.
Symptoms of aortic stenosis include chest pain or pressure, shortness of breath and heart palpitations. As the condition progresses, it can lead to heart failure, a serious and life-threatening problem that causes your heart to work too hard. Fortunately, you can slow the progression of heart valve disease by taking steps to prevent problems before they occur.
Preventive measures include avoiding unhealthy habits such as smoking, high blood pressure (hypertension) and obesity. If you have a family history of aortic valve disease, you should make sure to get regular health checkups.
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A doctor can diagnose aortic valve disease by examining you and asking about your symptoms and medical history. He or she may hear an abnormal sound when listening to your heart with a stethoscope, called a whooshing sound (heart murmur). Aortic valve disease often causes this sound. A health care provider also may order other tests to find out how bad your aortic valve is. These tests include electrocardiogram (EKG or ECG), chest X-ray and echocardiogram, which uses sound waves to create pictures of your heart and heart valves.
Take antibiotics if you have strep throat to help prevent rheumatic fever, which can damage your aortic valve. Wash your hands frequently to reduce your chances of getting an infection in the tissue around your heart and lungs (infective endocarditis). Brush and floss daily to keep your teeth and gums healthy and to lower your risk for periodontal (gum) disease, which increases your risk for aortic stenosis.
