Aortic Valve Disease
What is aortic valve disease?
Your heart has four valves which direct the flow of blood through the heart. Your aortic valve is located between the left ventricle and the aorta (the large blood vessel that carries blood to the rest of the body). When your ventricle contracts, blood is forced through the aortic valve, into the aorta, and out to the rest of your body. Your valve then closes as the ventricle relaxes and fills with blood. This prevents blood from moving backward into the left ventricle. The aortic valve normally has three flaps or leaflets.
What is aortic valve stenosis?
Aortic stenosis is a type of valve disease in which the leaflets of your aortic valve stiffen and do not open all the way. This creates a narrowed opening for blood to pass through. Your heart has to work harder to pump blood through this smaller opening. Aortic Insufficiency or regurgitation is another type of valve disease in which the valve does not close all the way.
What is aortic insufficiency or regurgitation?
Aortic insufficiency is a type of valve disease in which your aortic valve does not close all the way. This causes blood to leak backward into the ventricle instead of moving into the aorta. Because of this, your heart has to work harder in order to pump blood to the rest of your body.
What are the common reasons for valve disease?
Sometimes, the problem with your aortic valve is congenital, meaning you are born with it. A common congenital condition is a bicuspid aortic valve. Other times, problems are acquired, meaning they develop over time. Common acquired conditions include rheumatic fever, bacterial infections called endocarditis, hardening of the leaflets over time from calcium and fat deposits, and damage to your valve due to a heart attack.
What are the concerns and symptoms of aortic valve disease?
In patients with aortic stenosis, the left ventricle has to work harder to pump blood through the narrow valve opening. This may cause the heart muscle to enlarge and become less able to pump blood to the body effectively.
There are several symptoms associated with aortic valve disease. Symptoms can increase in severity as the disease progresses:
- Chest pain or tightness
- Feeling lightheaded or fainting with physical exertion
- Increased fatigue, especially with increased activity
- Shortness of breath
- Heart palpitations or abnormal heart beat
- Swollen ankles and feet
How is aortic stenosis diagnosed and evaluated?
Valve disease may be detected by your doctor during a routine medical exam. They may notice a heart murmur, which is the sound of blood flowing across an abnormal heart valve. A murmur may be the first clinical sign of valve disease if you have no symptoms. Your doctor may order an echocardiogram (an external ultrasound of your heart) to look at your heart valves.
- Echocardiogram: An echocardiogram or “echo” uses sound waves to create a picture of your heart. It shows the different structures of the heart and can show any abnormalities in your valves. There are two kinds of echocardiograms. Your doctors will determine which test is needed to get the best view of your heart valves. Learn more about echocardiograms
- Transthoracic echocardiograms (TTE): A TTE is done using an ultrasound probe held against the chest and is noninvasive.
- Transesophageal echocardiograms (TEE): A TEE is done by passing an ultrasound probe down the esophagus to get a close up view of your heart. This test is more invasive.
Non-Surgical Treatment Options
- Medical management: Depending on the severity, treatment with medications may be successful in managing your valve disease. Medications can be helpful in treating your symptoms, however they will not prevent or reverse the disease. It is important to keep close follow up with your heart doctor. This includes regular appointments, living a healthy lifestyle, and taking the medications to help your heart. You will likely have routine echocardiograms to monitor the progression of the disease.
- Valvuloplasty: This procedure uses a balloon catheter to stretch the opening of your narrowed valve to allow more blood to flow through. This procedure provides temporary relief of symptoms.
- Transcatheter Aortic Valve Replacement (TAVR): This procedure may be an option if you have aortic stenosis and are at intermediate or high risk for open heart surgery. TAVR allows the diseased heart valve to be replaced using a catheter and is less invasive than surgical aortic valve replacement. Candidacy for TAVR is determined through a series of screening tests and may not be available for all patients.
Surgical Treatment Options
If your aortic valve disease becomes severe and medications alone are no longer effective, aortic valve surgery may be necessary. This is a surgical procedure where your aortic valve is repaired or replaced by a properly functioning valve. It is the most common surgical intervention for aortic valve disease.