Aortic valve stenosis
Definition :
Aortic valve stenosis — or aortic stenosis — occurs when the heart's aortic valve narrows. This narrowing prevents the valve from opening fully, which obstructs blood flow from your heart into your aorta and onward to the rest of your body.
When the aortic valve is obstructed, your heart needs to work harder to pump blood to your body. Eventually, this extra work limits the amount of blood it can pump and may weaken your heart muscle, leading to symptoms, such as fatigue and dizziness.
If you have severe aortic valve stenosis, you'll usually need surgery to replace the valve. Left untreated, aortic valve stenosis can lead to serious heart problems.
Symptoms:
Aortic valve stenosis ranges from mild to severe. Aortic valve stenosis signs and symptoms typically develop when narrowing of the valve is severe and can include:
Aortic valve stenosis may not produce warning signs right away, making it difficult to detect at first. The condition is often discovered during a routine physical when a doctor hears an abnormal heart sound (heart murmur). This murmur may occur long before other signs and symptoms develop.
Depending on the amount of narrowing, an infant or child with aortic valve stenosis may have no symptoms, may tire easily or may have chest pain with vigorous physical activity.
When to see a doctor
Aortic valve stenosis usually affects adults, but can occur in children. Infants and children with the condition may experience symptoms similar to those of adults. If you or your child experiences such signs or symptoms, see a doctor — especially if you or your child has a known heart problem.
Causes:
Aortic valve stenosis is narrowing of the aortic valve. Many things can narrow this passageway between your heart and aorta. Causes of aortic valve stenosis include:
Your heart, the center of your circulatory system, consists of four chambers. The two upper chambers, the atria, receive blood. The two lower chambers, the ventricles, pump blood.
Blood returning to your heart enters the right upper chamber (right atrium). From there, blood empties into the right ventricle underneath. The right ventricle pumps blood into your lungs, where blood is oxygenated. Blood from your lungs then returns to your heart, but this time to the left side — to the left upper chamber (left atrium). Blood then flows into the left ventricle — your heart's main pump. With each heartbeat, the left ventricle forces blood through the aortic valve into the aorta, your body's largest artery.
Blood flows through your heart's chambers, aided by four heart valves. These valves open and close to let blood flow in only one direction through your heart:
Heart valves open like a one-way gate. The leaflets of the aortic valve are forced open as the left ventricle contracts and blood flows into the aorta. When all of the left ventricular blood has gone through the valve and the left ventricle has relaxed, the leaflets swing closed to prevent the blood that has just passed into the aorta from flowing back into the left ventricle.
A defective heart valve is one that fails to either open or close fully. When a valve doesn't close tightly, blood can leak backward. This backward flow through a valve is called regurgitation. When a valve narrows, the condition is called stenosis.
Complications:
Aortic valve stenosis — of any cause — can be a serious condition because it can weaken the heart. If the aortic valve is narrowed, the left ventricle has to work harder to pump a sufficient amount of blood into the aorta and onward to the rest of your body. In response, the left ventricle may thicken and enlarge. At first these adaptations help the left ventricle pump blood with more force. But eventually these changes weaken the left ventricle — and your heart overall.
Left unchecked, aortic valve stenosis can lead to life-threatening heart problems, including:
Medications sometimes can ease symptoms of aortic valve stenosis. However, the only way to eliminate aortic valve stenosis is surgery to repair or replace the valve and open up the passageway.
Surgery isn't always needed right away. If tests reveal that you have mild to moderate aortic valve stenosis and you have no symptoms, your doctor will schedule checkups to carefully monitor the valve so that surgery can be done at the appropriate time.
In general, surgery is necessary when narrowing becomes severe and symptoms develop. Some people never develop severe aortic valve stenosis, so they never need surgery. For others, the condition gets worse and surgery is necessary.
Medications
No medications can reverse aortic valve stenosis. However, your doctor may prescribe certain medications to help your heart, such as ones to control heart rhythm disturbances associated with aortic valve stenosis. Lowering blood pressure or cholesterol may prevent or slow the development of aortic stenosis. Ask your doctor if you need to lower your cholesterol or blood pressure with medications.
Procedures
You may need valve repair or replacement to treat aortic valve stenosis. Although less invasive approaches are possible in some cases, surgery is the primary treatment for this condition.
Therapies to repair or replace the aortic valve include:
If you've had aortic valve replacement surgery, you may need to take antibiotics before certain dental or medical procedures due to the risk of infection in your heart tissue (endocarditis).
Definition :
Aortic valve stenosis — or aortic stenosis — occurs when the heart's aortic valve narrows. This narrowing prevents the valve from opening fully, which obstructs blood flow from your heart into your aorta and onward to the rest of your body.
When the aortic valve is obstructed, your heart needs to work harder to pump blood to your body. Eventually, this extra work limits the amount of blood it can pump and may weaken your heart muscle, leading to symptoms, such as fatigue and dizziness.
If you have severe aortic valve stenosis, you'll usually need surgery to replace the valve. Left untreated, aortic valve stenosis can lead to serious heart problems.
Symptoms:
Aortic valve stenosis ranges from mild to severe. Aortic valve stenosis signs and symptoms typically develop when narrowing of the valve is severe and can include:
- Chest pain (angina) or tightness
- Feeling faint or fainting with exertion
- Shortness of breath, especially with exertion
- Fatigue, especially during times of increased activity
- Heart palpitations — sensations of a rapid, fluttering heartbeat
- Heart murmur
Aortic valve stenosis may not produce warning signs right away, making it difficult to detect at first. The condition is often discovered during a routine physical when a doctor hears an abnormal heart sound (heart murmur). This murmur may occur long before other signs and symptoms develop.
Depending on the amount of narrowing, an infant or child with aortic valve stenosis may have no symptoms, may tire easily or may have chest pain with vigorous physical activity.
When to see a doctor
Aortic valve stenosis usually affects adults, but can occur in children. Infants and children with the condition may experience symptoms similar to those of adults. If you or your child experiences such signs or symptoms, see a doctor — especially if you or your child has a known heart problem.
Causes:
Aortic valve stenosis is narrowing of the aortic valve. Many things can narrow this passageway between your heart and aorta. Causes of aortic valve stenosis include:
- Congenital heart defect. The aortic valve consists
of three tightly fitting, triangular-shaped flaps of tissue called
leaflets. Some children are born with an aortic valve that has only one
(unicuspid) or two (bicuspid) leaflets — not three. This deformity may
not cause any problems until adulthood, at which time the valve may
begin to narrow or leak and may need to be repaired or replaced. Having a
unicuspid or bicuspid aortic valve requires regular evaluation by a
doctor to watch for signs of valve problems. In most cases, doctors
don't know why a heart valve fails to develop properly, so it isn't
something you could have prevented.
- Calcium buildup on the valve. With age, heart
valves may accumulate deposits of calcium (aortic valve calcification).
Calcium is a mineral found in your blood. As blood repeatedly flows over
the aortic valve, deposits of calcium can accumulate on the valve's
leaflets. These deposits may never cause any problems. However, in some
people — particularly those with a bicuspid aortic valve — calcium
deposits result in stiffening of the leaflets of the valve. This
stiffening narrows the aortic valve. This cause of aortic valve stenosis
is most common in people older than 65, and symptoms often don't appear
until age 70.
- Rheumatic fever. A complication of strep throat infection, rheumatic fever may result in scar tissue forming on the aortic valve. Scar tissue alone can narrow the aortic valve and lead to aortic valve stenosis. Scar tissue can also create a rough surface on which calcium deposits can collect, contributing to aortic valve stenosis later in life. Rheumatic fever may damage more than one heart valve, and in more than one way. A damaged heart valve may not open fully or close fully — or both. While rheumatic fever is rare in the United States, some older adults had rheumatic fever as children.
Your heart, the center of your circulatory system, consists of four chambers. The two upper chambers, the atria, receive blood. The two lower chambers, the ventricles, pump blood.
Blood returning to your heart enters the right upper chamber (right atrium). From there, blood empties into the right ventricle underneath. The right ventricle pumps blood into your lungs, where blood is oxygenated. Blood from your lungs then returns to your heart, but this time to the left side — to the left upper chamber (left atrium). Blood then flows into the left ventricle — your heart's main pump. With each heartbeat, the left ventricle forces blood through the aortic valve into the aorta, your body's largest artery.
Blood flows through your heart's chambers, aided by four heart valves. These valves open and close to let blood flow in only one direction through your heart:
- Tricuspid valve
- Pulmonary valve
- Mitral valve
- Aortic valve
Heart valves open like a one-way gate. The leaflets of the aortic valve are forced open as the left ventricle contracts and blood flows into the aorta. When all of the left ventricular blood has gone through the valve and the left ventricle has relaxed, the leaflets swing closed to prevent the blood that has just passed into the aorta from flowing back into the left ventricle.
A defective heart valve is one that fails to either open or close fully. When a valve doesn't close tightly, blood can leak backward. This backward flow through a valve is called regurgitation. When a valve narrows, the condition is called stenosis.
Complications:
Aortic valve stenosis — of any cause — can be a serious condition because it can weaken the heart. If the aortic valve is narrowed, the left ventricle has to work harder to pump a sufficient amount of blood into the aorta and onward to the rest of your body. In response, the left ventricle may thicken and enlarge. At first these adaptations help the left ventricle pump blood with more force. But eventually these changes weaken the left ventricle — and your heart overall.
Left unchecked, aortic valve stenosis can lead to life-threatening heart problems, including:
- Chest pain (angina)
- Fainting (syncope)
- Heart failure
- Irregular heart rhythms (arrhythmias)
- Cardiac arrest
Medications sometimes can ease symptoms of aortic valve stenosis. However, the only way to eliminate aortic valve stenosis is surgery to repair or replace the valve and open up the passageway.
Surgery isn't always needed right away. If tests reveal that you have mild to moderate aortic valve stenosis and you have no symptoms, your doctor will schedule checkups to carefully monitor the valve so that surgery can be done at the appropriate time.
In general, surgery is necessary when narrowing becomes severe and symptoms develop. Some people never develop severe aortic valve stenosis, so they never need surgery. For others, the condition gets worse and surgery is necessary.
Medications
No medications can reverse aortic valve stenosis. However, your doctor may prescribe certain medications to help your heart, such as ones to control heart rhythm disturbances associated with aortic valve stenosis. Lowering blood pressure or cholesterol may prevent or slow the development of aortic stenosis. Ask your doctor if you need to lower your cholesterol or blood pressure with medications.
Procedures
You may need valve repair or replacement to treat aortic valve stenosis. Although less invasive approaches are possible in some cases, surgery is the primary treatment for this condition.
Therapies to repair or replace the aortic valve include:
- Balloon valvuloplasty (valvotomy). Occasionally,
repairing the aortic valve is an option. Balloon valvuloplasty uses a
soft, thin tube (catheter) tipped with a balloon. A doctor guides the
catheter through a blood vessel in your arm or groin to your heart and
into your narrowed aortic valve. Once in position, a balloon at the tip
of the catheter is inflated. The balloon pushes open the aortic valve
and stretches the valve opening, improving blood flow. The balloon is
then deflated and the catheter with balloon is guided back out of your
body. Balloon valvuloplasty may relieve aortic valve stenosis and its
symptoms, especially in infants and children. However, in adults, the
procedure isn't usually successful, and the valve tends to narrow again
even after initial success. For these reasons, doctors rarely use
balloon valvuloplasty today to treat aortic valve stenosis in adults,
except in people who are too sick to undergo surgery.
- Aortic valve replacement. This is the primary
surgical treatment for aortic valve stenosis. Your surgeon removes the
narrowed aortic valve and replaces it with a mechanical valve or a
tissue valve. Mechanical valves, made from metal, are durable, but they
carry the risk of blood clots forming on or near the valve. If you
receive a mechanical valve, you'll need to take an anticoagulant
medication, such as warfarin (Coumadin), for life to prevent blood
clots. Tissue valves — which may come from a pig, cow or human deceased
donor — often eventually need to be replaced. Another type of tissue
valve replacement that uses your own pulmonary valve (autograft) is
sometimes possible. Your doctor can discuss the risks and benefits of
each type of heart valve with you.
- Transcatheter aortic valve replacement (TAVR). Aortic
valve replacement, the most common treatment for aortic valve stenosis,
has traditionally been performed with open-heart surgery. A less
invasive approach — transcatheter aortic valve replacement — involves
replacing the aortic valve with a prosthetic valve via the femoral
artery in your leg (transfemoral) or the left ventricular apex of your
heart (transapical). TAVR is usually reserved for individuals at
increased risk of complications from aortic valve surgery. TAVR is
sometimes referred to as transcatheter aortic valve implantation (TAVI).
- Surgical valvuloplasty. In rare cases, surgical repair may be a more effective option than balloon valvuloplasty, such as in infants born with an aortic valve in which the leaflets of the valve are fused together. Using traditional surgical tools, a cardiac surgeon operates on the valve and separates these leaflets to reduce stenosis and improve blood flow.
If you've had aortic valve replacement surgery, you may need to take antibiotics before certain dental or medical procedures due to the risk of infection in your heart tissue (endocarditis).
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