Aortic Valve Stenosis

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Overview

What is the aortic valve? What is aortic valve stenosis?

The heart has four chambers . In the lower left chamber (left ventricle), the aortic valve works like a one-way gate. When the heart pumps, the aortic valve opens to let oxygen-rich blood flow from the left ventricle into a large blood vessel called the aorta. Blood then flows through the aorta to the rest of the body.

Aortic valve stenosis means that this valve has narrowed, and it can't open all the way. The heart has to work harder to pump blood through the smaller opening. The heart can do this for many years, but over time it gets worn out. It can no longer send out as much blood as your body needs. If you don't get treatment, heart failure may develop.

What causes aortic valve stenosis?

Problems that can cause aortic valve stenosis include:

• Calcium buildup on the aortic valve. As you age, calcium can build up on the valve, making it hard and thick. This buildup happens over time, so symptoms usually don't appear until after age 65. Many of the same things that increase your risk for hardening of the arteries (atherosclerosis) make you more likely to have aortic valve stenosis. They include smoking, being male, or having high cholesterol, high blood pressure, or diabetes.
• A heart defect you were born with (congenital). Some babies are born with an aortic valve that has only two flaps instead of the normal three. This is called a bicuspid valve, and it makes a smaller opening for blood to flow through. In this case, symptoms usually start around age 40.
• Rheumatic fever or endocarditis. These infections can damage the valve.

What are the symptoms?

Aortic valve stenosis is a slow process. For many years, even decades, you will not feel any symptoms. But at some point, the valve will likely become so narrow (often one-fourth of its normal size) that you start having problems.

As aortic valve stenosis gets worse, you may have symptoms such as:

• Chest pain (angina). You may have a heavy, tight feeling in your chest. Chest pain is often brought on by exercise, when the heart has to work harder.
• Feeling dizzy or faint, often after you have been active.
• Feeling tired and being short of breath when you are active.
• A fast, slow, or uneven heartbeat (arrhythmia).
• A feeling that your heart is pounding, racing, or beating unevenly (palpitations).

If you start to notice any of these symptoms, let your doctor know right away. By the time you have symptoms, your condition probably is serious. About 15 to 20 out of 100 people who have symptoms of aortic valve stenosis die suddenly.¹ If you have symptoms, you need treatment.

How is aortic valve stenosis diagnosed?

Most people find out they have it when their doctor hears a heart murmur during a regular physical exam. To be sure of the diagnosis, your doctor may want you to have an echocardiogram, which can show moving pictures of your heart. You may have other tests to help your doctor judge how well your heart is working.

How is it treated?

If symptoms develop, you will probably need surgery right away. Surgery to replace the aortic valve is the best treatment for most people. Young people or people who cannot have open-heart surgery may have another procedure called balloon valvuloplasty to enlarge the valve opening.

If you do not have surgery after you start having symptoms, you may die suddenly or develop heart failure. People who have heart failure but do not have surgery to replace the valve usually die within 2 years.² Surgery can help you have a more normal life span.

If you don't have symptoms, your doctor will see you regularly to check your heart. You probably will not have surgery. Until you have symptoms, surgery is likely to be more risky than the disease.³

Medicines do not cure the disease, but they can treat some problems that aortic valve stenosis can cause. You might need to take medicines that help control irregular heart rhythms or blood thinners (anticoagulants) to prevent blood clots.

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Last updated:	November 17, 2005
Author:	Robin Parks, MS
Reviewed By:	E. Gregory Thompson, MD - Internal Medicine, George Philippides, MD - Cardiology
Editors:	Kathleen M. Ariss, MS, Pat Truman