Aortic valve stenosis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 30, 2016
StartDiseasesAortic valve stenosis

Aortic valve stenosis is a narrowing of the aortic valve opening. It causes a restriction of blood flow through the body. When severe, it can cause sudden death.

Contents

Definition & Facts

The aortic valve does not open properly when a patient has aortic valve stenosis. It is one of the most common and one of the most serious valve diseases. When the valve does not work properly, the blood flow from the left ventricle of the heart to the aorta is decreased which then affects the pressure in the left atria of the heart.

Most people do not know that they have aortic valve stenosis until the disease is quite severe because it presents few, if any, symptoms when it is mild. Severe aortic valve stenosis needs to be treated right away to prevent death.

Symptoms & Complaints

Aortic valve stenosis starts off mild and can become more severe over time. When a person has mild aortic valve stenosis, they may not even know it for many years unless they happen to have an echocardiogram. If mild stenosis is observed on an echocardiogram, patients should follow up regularly with their doctor.

Severe symptoms may start appearing when the amount of blood flow through the aortic valve has become significantly reduced. Patients may experience symptoms such as breathlessness, chest pain, chest pressure, or chest tightness, fainting, heart palpitations or heavy and noticeable beating of the heart, declined activity, or a restriction of activities that require any exertion.

Patients, especially the elderly, may not complain of any symptoms, but if caregivers notice reduced activity, extreme tiredness from mild exertion, or breathlessness, then it is important to have the patient checked out by their health care provider. Infants and children who have aortic valve stenosis may exhibit the following symptoms and behaviors: fatigue upon exertion, failure to gain weight, poor feeding or appetite, and breathing problems.

Causes

Aortic valve stenosis is usually due to age, but it can also be caused by a congenital birth defect in some babies. When a person over age 70 develops aortic valve stenosis, it is almost certainly afflicting a normal aortic valve. Over time, the valve calcifies and does not move as well as it used to. When it moves so little that only minimal blood can get through it, then problems arise and symptoms become severe. This is the most common cause of aortic valve stenosis.

However, there are two other possibilities. In people approximately aged 30-70 who develop the issue, it is likely that their heart valve is a bicuspid aortic valve instead of a normally formed one. Since there are only two parts to open instead of three, they work harder throughout life and can become calcified or simply not work well. This bicuspid valve is a congenital heart defect that often goes unnoticed since it does not cause problems until adulthood.

On the other hand, infants sometimes have a valve that does not grow with the heart. This small valve opening does not allow for adequate blood to pump through the heart. It has to work harder to get the blood to flow and over the years, it calcifies and becomes stiffer and narrower.

Diagnosis & Tests

Diagnosis of aortic valve stenosis is often difficult, especially in the early stages when symptoms do not show and no testing is initiated. However, early diagnosis of aortic valve stenosis can be done with an echocardiogram. An echocardiogram is an ultrasound of the heart and its valves. During the echocardiogram, measurements can be taken of the aortic valve to determine how much of it is working. If aortic valve stenosis is mild, most of it will still be working.

Unlike some diseases where early diagnosis is important, very little will be done to treat mild cases of aortic valve stenosis except for monitoring. Generally, it progresses only a small amount each year. Thus, yearly monitoring via echocardiograms should be performed in patients with early stages of the disease to keep tabs on its progress.

In addition, patients and caregivers should pay careful attention to symptoms, and they should note any that become worse. When symptoms become significant, patients should consult with their health care provider immediately. When an echocardiogram shows that significant blood flow is reduced, it will be time for treatment.

Treatment & Therapy

Treatment of aortic valve stenosis generally requires cardiac surgery to repair or replace the faulty valve. When it is determined that a person's stenosis is causing severe restriction of blood flow, it is usually time to do surgery, and there is typically no time to wait. Surgery should be done as quickly as possible because failure to do so can result in sudden death.

Replacement of the heart valve typically involves open heart surgery though some newer techniques are being developed that may make the procedure less invasive in the future. There are several different types of replacement heart valves. Mechanical valves are made of metal, and they work very well, but put the patient at risk for blood clots on or near the valve. Medication can reduce this risk.

Tissue valves, typically from pigs, cows, or humans, are another option, but these do not tend to last more than 10 years. A different type of treatment, balloon valvuloblasty may be recommended in some cases, especially in children and young adults and those who are at too high of a risk for typical surgery. This procedure is less invasive and can open the valve, but it is usually only a temporary solution.

Prevention & Prophylaxis

There are a few steps that a person can take to reduce their risk of developing aortic valve stenosis. In general, a person should live a healthy lifestyle including a healthy diet, plenty of rest, and regular exercise. In addition, if a person smokes, he or she should quit, and he or she should be aware of other risk factors such as obesity, high blood pressure, and high cholesterol. Keeping these values in the normal range will reduce the chances of developing aortic valve stenosis.

In addition, one should take steps to prevent rheumatic fever which can be brought on by untreated strep throat. Finally, one should care of their teeth and gums. Gum disease has been linked to infections of the heart which can leave scar tissue that narrows the heart valves and leads to stenosis. Once a person has been diagnosed with aortic valve stenosis, his or her doctor should advise the patient to avoid strenuous activity, but this will be determined based on the severity of the problem.