Aortic Valve Disease

Aortic valve disease is a type of heart valve disease. In this condition, the valve between the lower left heart chamber and the body’s main artery does not work properly.

The aortic valve helps blood flow in the right direction through the heart. A damaged or diseased aortic valve can affect blood flow to the heart and the rest of the body.

Aortic valve disease includes:

Aortic valve stenosis: Each heart valve has tissue valves that open and close once the heart beats. Flaps are also called tubercles. Sometimes the aortic valves become thick and stiff or tied together. These problems cause the valve opening to narrow. The narrowed valve reduces or blocks blood flow from the heart to the rest of the body.

Aortic valve insufficiency: The aortic valve does not close properly, causing blood to flow back into the lower left heart chamber.

A person can be born with aortic valve disease. This is called a congenital heart defect. Sometimes aortic valve disease can occur later in life due to other health conditions.

Treatment of aortic valve disease depends on the type and severity of the disease. Some people may need surgery to repair or replace the aortic valve.

Symptoms

Some people with aortic valve disease may not notice symptoms for many years. Symptoms of aortic valve disease may include:

• Chest pain or tightness.
• Dizziness.
• Fainting.
• Fatigue after activity or decreased ability to be active.
• Irregular heartbeat.
• Shortness of breath, especially during vigorous activity or when lying down.
• Not eating enough. This is most often seen in children with aortic valve stenosis.
• Not gaining enough weight. This is most often seen in children with aortic valve stenosis.

Reasons

Aortic valve disease can be caused by a heart problem that is present at birth, called a congenital heart defect. Other causes of aortic valve disease later in life include:

• Age-related changes in the heart.
• Infections.
• Hypertension.
• Injury to the heart.

To better understand the causes of aortic valve disease, it can be helpful to know how heart valves typically work.

The heart has four valves that keep blood flowing in the right direction. These valves:

• Aortic valve.
• Ax mitral.
• Tricuspid valve.
• Lung valve.

Each valve has flaps, also called valves or leaflets, that open and close once during each heartbeat.

In aortic valve disease, the valve between the lower left heart chamber and the body’s main artery does not work properly. The lower left heart chamber is called the left ventricle. The main artery of the body is called the aorta.

The valve may become thick and stiff, or the valve may not close properly.

Risk factors

Many things can increase the risk of aortic valve disease, including:

Older age: As people get older, calcium can build up in the aortic valve, causing it to harden and narrow.

Heart valve problems present at birth are called congenital heart defects: Some people are born with missing, extra, or fused valve covers. This increases the risk of aortic valve regurgitation.

Rheumatic fever: This complication of strep throat can cause aortic stenosis, a type of heart valve disease. If you have heart valve disease due to rheumatic fever, it is called rheumatic heart disease. Otherwise, it is called non-rheumatic heart disease.

Inflammation of the inner surface of the heart chambers and valves, called endocarditis: This life-threatening condition is usually caused by infection. It may damage the aortic valve.

History of chest radiation therapy: Some types of cancer are treated with radiation therapy. Symptoms of heart valve disease may not be noticed for years after receiving radiation therapy.

Other health conditions: Chronic kidney disease, lupus, and Marfan syndrome, a connective tissue disease, may increase the risk of aortic stenosis or regurgitation.

Complications

Potential complications of aortic valve disease may include:

• Blood clots.
• Paralysis.
• Heart failure.
• Heart rhythm problems called arrhythmias.
• Death due to sudden cardiac arrest.

Correct diagnosis and treatment can help reduce the risk of complications.

Diagnosis

To diagnose aortic valve disease, a healthcare professional will examine you and ask questions about your symptoms and medical history.

When listening to the heart with a stethoscope, a whistling sound called a heart murmur may be heard. If so, you may need to see a doctor with training in heart disease, called a cardiologist.

Tests

Tests to diagnose aortic valve disease include:

Echocardiogram: An echocardiogram uses sound waves to create pictures of the beating heart. It shows how blood flows through the heart and heart valves. It can help determine the severity of aortic valve disease.
There are different types of echocardiograms. The type you have depends on the information your healthcare team needs. A standard echocardiogram is done from outside the body. The ultrasound device is gently pressed against the skin of the chest above the heart. If more details about the heart are needed, a transesophageal echocardiogram may be performed. This type creates pictures of the heart from inside the body. The ultrasound device is connected to a tube that goes down your throat into your esophagus.

Electrocardiogram (ECG or EKG): This rapid test records the electrical activity of the heart. It shows how the heart beats. Adhesive patches are placed on the chest and sometimes on the legs. Cables connect the patches to a computer that displays or prints the results.

Chest x-ray: A chest x-ray shows the condition of the heart and lungs. It can help determine whether the heart is enlarged, which can be a sign of certain types of aortic valve disease or heart failure.

Cardiac MRI: Cardiac MRI uses magnetic fields and radio waves to create detailed pictures of the heart. This test can be used to determine the severity of aortic valve disease and measure the size of the aorta.

Cardiac computed tomography (CT) scan: A cardiac CT scan uses a series of X-rays to create detailed images of the heart and heart valves. The test may be done to measure the size of the aorta and take a closer look at the aortic valve. A CT scan may also be used to measure the amount of calcium in the aortic valve or to determine the severity of aortic valve stenosis.

Exercise tests or stress tests: These tests usually involve walking on a treadmill or riding a stationary bike while an ECG or echocardiogram is performed. Exercise tests show how your heart responds to physical activity and whether valve disease symptoms occur during exercise. If you cannot exercise, you can take medications that affect the heart, such as exercise.

Heart catheterization: This test is not often used to diagnose aortic valve disease. However, it may be done to see how severe aortic valve disease is or to diagnose the condition if other tests fail. In this test, a thin, flexible tube is inserted into a blood vessel, usually in the groin area or arm, and guided to the heart. Cardiac catheterization can provide more details about blood flow and how well the heart is working. Some heart treatments may be performed during cardiac catheterization.

Staging

Once the test confirms the diagnosis of aortic or other valve disease, your healthcare team can tell you the stage of the disease. Staging helps determine the most appropriate treatment.

The stage of heart valve disease depends on many things, including symptoms, severity of disease, structure of the valve or valves, and blood flow in the heart and lungs.

Heart valve disease is divided into four basic groups:

Stage A: At risk There are risk factors for heart valve disease.

Stage B: Gradual Valve disease is mild or moderate. There are no heart valve symptoms.

Stage C: Asymptomatic severe There are no heart valve symptoms, but valve disease is serious.

Stage D: Symptomatic severe Heart valve disease is serious and causes symptoms.

Treatment

Treatment of aortic valve disease depends on:

• Severity (stage) of aortic valve disease.
• Whether the disease causes symptoms.
• Whether the situation is getting worse or not.

Treatment may include regular health checks, lifestyle changes, medications, or surgery or other procedures. If you have aortic valve disease, consider being evaluated and treated at a medical center with a multidisciplinary team of heart doctors called cardiologists and other care professionals who are trained and experienced in evaluating and treating heart valve disease.

Medicines

If aortic valve disease is mild or moderate or you have no symptoms, you may only need regular medical checkups to monitor the condition.

Heart-healthy lifestyle changes and medications may be needed to treat symptoms of aortic valve disease or reduce the risk of complications. For example, medications can be used to:

• Lower blood pressure.
• Prevent irregular heartbeats.
• Remove excess fluid from the body to reduce the burden on the heart.

Surgery or other procedures

Eventually, surgery or a catheter procedure may be required to repair or replace the diseased aortic valve. Some people with aortic valve disease need surgery even if the disease is not severe or does not cause symptoms.

Surgery to repair or replace the aortic valve is usually done via open-heart surgery. Sometimes the valve can be replaced during minimally invasive heart surgery or through a catheter-based procedure, which uses smaller incisions than are required for open-heart surgery.

Aortic valve repair

During aortic valve repair, the surgeon may do one or all of the following:

• Fused separate valve covers.
• Add support to the base of the valve.
• Reshape or remove excess valve tissue so that the valves can close tightly.
• Patch holes or tears in the valve.

Aortic valve repair often requires open heart surgery. However, less invasive options may be available. For example, a catheter procedure may be used to insert a plug or device to repair a leaking replacement aortic valve.

In infants and children with aortic valve stenosis, a less invasive procedure called balloon valvuloplasty may be done to temporarily open the narrowed valve. During this procedure, the doctor inserts a thin, hollow tube into a blood vessel, usually in the groin, and connects it to the heart. A balloon is inflated to widen the valve opening. The balloon is then deflated and removed. This valve repair procedure can also be performed on adults who are too sick to have surgery or are waiting for a valve replacement.

Aortic valve replacement

In an aortic valve replacement, the surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue. The tissue valve is called biological tissue valve.

Sometimes the aortic valve is replaced with your own lung valve, called the pulmonary valve. Your lung valve is then replaced with a biological lung tissue valve. This more complex surgery is called the Ross procedure.

You and your healthcare team will discuss the benefits and risks of each type of valve to choose the best option for you.

Aortic valve replacement usually requires open heart surgery. Sometimes surgeons may use a minimally invasive procedure called transcatheter aortic valve replacement (TAVR) to replace the narrowed aortic valve with a biological tissue valve. TAVR uses smaller incisions than those used in open-heart surgery. TAVR may be an option for people at high risk of complications from heart valve surgery.

Lifestyle and home remedies

After diagnosis or treatment of aortic valve disease, you will need regular health checks. Your healthcare team may recommend you make heart-healthy lifestyle changes. Try these steps:

Eat a heart-healthy diet: Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish and whole grains. Avoid saturated and trans fats, excess salt and sugar.

Maintain a healthy weight: Ask your healthcare team what a healthy weight is for you.

Exercise regularly: As a general goal, aim for at least 30 minutes of moderate physical activity every day. Check with your healthcare team before starting a new exercise routine.

Manage stress: Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness, and connecting with others in support groups are some ways to relieve stress.

Do not smoke: If you need help quitting smoking or using tobacco, consult a healthcare professional about resources to help. Joining a support group may be helpful.

Pregnancy

If you have aortic valve disease, it is important to talk to a healthcare professional before getting pregnant. If you have aortic valve disease during pregnancy, careful and regular check-ups are needed. Your healthcare team can discuss with you which medications are safe to use during pregnancy. Your healthcare team can also determine whether treatment for valve disease is necessary before pregnancy.

Health professionals may recommend that people with severe heart valve disease avoid pregnancy to avoid the risk of complications.

Coping and support

If you have aortic valve disease, here are some steps that can help you manage this condition:

Take medications as prescribed: Take your medications as directed by your healthcare team.

Get support: It can be helpful to connect with others who have the same or similar situation. Ask your healthcare team about support groups in your area.

Stay active: Regular exercise is one of the best ways to improve heart health. Ask a healthcare professional how much and what type of physical activity is safe for you.