Aortic Valve Disease

What is aortic valve disease? Aortic valve disease is a group of conditions that affect your aortic valve and prevent it from working as it should. Your aortic valve is the “door” that manages blood flow out of your heart to the rest of your body. This valve allows blood to travel from your heart’s main pumping chamber (left ventricle) into a large artery called your aorta. From there, your blood travels into many artery branches to supply oxygen and nutrients to your organs and tissues. Your aortic valve opens and closes each time your heart beats. It needs to open widely to create enough space for blood to pass through. It also has to close tightly to prevent blood from flowing backward. If your valve has problems with either or both of these tasks, you have aortic valve disease. There are two types of aortic valve disease: Aortic valve stenosis (aortic stenosis). This is a narrowed aortic valve. Your valve can’t open as widely as it should. As a result, less blood can pass through. Aortic valve regurgitation (aortic insufficiency). This is a leaky aortic valve. Your valve can’t close as tightly as it should. So, some blood leaks backward. It’s important to know that you could have one or both types of aortic valve disease and not realize it for a long time. That’s because symptoms often don’t show up until after the disease has progressed. Learning about aortic valve disease can help you catch problems early and receive necessary treatment.

Who does aortic valve disease affect? Aortic valve disease can affect anyone, but it typically affects people who: Are over age 60. Were born with a bicuspid aortic valve. Were born with congenital heart disease. Underwent radiation therapy to the chest for cancers, including Hodgkin Lymphoma. Have rheumatic heart disease. Your risk of aortic valve disease increases the older you get. In the U.S., about 1 in 50 people over age 65 have aortic stenosis. Some estimates show 1 in 20 people have at least a mild form of aortic regurgitation. About 1 in 3 people born with a bicuspid aortic valve develop aortic stenosis. This narrowing typically happens 10 to 20 years sooner compared with people who have normal valve anatomy.

How common is aortic valve disease? Aortic valve disease is the most common form of heart valve disease in the U.S. and Europe. It’s also the most dangerous. Aortic valve disease causes about 6 in 10 deaths due to heart valve disease. That’s more than all the deaths from mitral, pulmonary and tricuspid valve disease combined.

What are the symptoms of aortic valve disease?

Early on, you may have no symptoms. As aortic valve disease gets worse, you may experience:

- Chest pain or discomfort.

- Fainting (syncope).

- Heart palpitations.

- Shortness of breath (dyspnea) with exertion, when lying down or when sleeping.

- Swelling (edema) in your feet and ankles.

What causes aortic valve disease?

Causes of aortic valve disease include:

- Wear and tear due to aging.

- Rheumatic heart disease.

- Congenital heart disease.

- High blood pressure.

- Endocarditis.

- Trauma to your chest.

-Thoracic aortic aneurysm.

- Aortic dissection.

- Radiation to your chest (such as treatment for cancer).

What are the risk factors?

You face a higher risk for aortic valve disease if you:

- Are over age 60.

- Have aortic valve sclerosis (thickening and calcification of your valve that doesn’t yet narrow the opening).

- Have a congenital heart valve defect, especially a bicuspid aortic valve.

- Have a history of rheumatic fever.

- Have a history of endocarditis.

- Have certain underlying conditions, including Marfan syndrome, Ehlers-Danlos syndrome and lupus.

What are the stages of aortic valve disease?

Aortic valve disease gradually gets worse over time. Healthcare providers use these stages to describe the severity of your condition:

Stage A (at risk): Your aortic valve is working fine, but you have at least one risk factor for aortic valve disease.

Stage B (progressive): This is mild or moderate aortic valve disease. There are some changes to your valve function, but you don’t have symptoms.

Stage C (asymptomatic severe): This is severe aortic valve disease. You don’t have symptoms during your normal routine. However, you may feel some symptoms during an exercise stress test. In stage C1, your heart can still pump out enough blood to meet your body’s needs. In stage C2, your heart can’t pump out enough blood (your left ventricular ejection fraction is below 50%).

Stage D (symptomatic severe): You have severe aortic valve disease that causes symptoms during your daily life. Early on, you may only have symptoms during physical activity. But later, you may have symptoms at rest.

What are the complications of aortic valve disease?

Aortic valve disease is serious and can lead to complications when untreated. The most common complication is heart failure. This is when your heart can’t pump enough blood to meet your body’s needs. Other complications include:

- Arrhythmia.

- Heart attack.

- Sudden cardiac arrest.

- Stroke.

How is aortic valve disease diagnosed?

Healthcare providers diagnose aortic valve disease through a physical exam and testing.

- During an exam, a provider:

- Asks about your medical history.

- Checks your vital signs.

- Uses a stethoscope to listen to your heart (auscultation). A murmur may indicate aortic valve disease.

- Performs an electrocardiogram (ECG).

You may also need one or more additional tests. An echocardiogram is the gold standard for diagnosing aortic valve disease. This test uses high-frequency sound waves (ultrasound) to take pictures of your heart.

Other tests you may need include:

- Cardiac catheterization.

- Cardiac computed tomography (CT) scan.

- Chest X-ray.

- Coronary angiogram.

- Exercise stress test.

- Heart MRI.

What is the treatment for aortic valve disease?

Treatment depends on:

- The specific type of aortic valve disease you have (stenosis, regurgitation or both).

- How far it’s progressed (the stage).

- The severity of your symptoms.

Your healthcare provider will evaluate your situation and recommend the best treatment plan for you. Treatment options include:

Medications. Medications can’t fix your valve, but they manage your symptoms and reduce your risk of complications. Your provider may prescribe medications to prevent arrhythmias, lower your blood pressure, manage your cholesterol or treat heart failure.

Valvuloplasty. This minimally invasive procedure uses a small balloon to open up your aortic valve. This improves blood flow through your valve if you have aortic stenosis. It’s a temporary solution until you have valve surgery.

Heart valve surgery. Surgery repairs or replaces your aortic valve with either a tissue valve or a mechanical heart valve. Surgeons sometimes combine valve surgery with coronary artery bypass grafting (CABG) or other heart surgeries.

Transcatheter aortic valve replacement (TAVR). TAVR is a minimally invasive alternative to traditional heart valve surgery. It avoids having to undergo open heart surgery, instead delivering you a new aortic valve without removing your old valve. Your new valve fits inside your old valve.

Ross procedure. This surgery helps people under age 60 who need a new aortic valve. A surgeon replaces your aortic valve with your pulmonary valve, and then gives you a donor pulmonary valve. This procedure can help avoid having to place a mechanical heart valve in the aortic position, but it’s a more complicated procedure.