Aortic Valve Stenosis

What is aortic valve stenosis?

Aortic valve stenosis is when one of the valves in the heart cannot open all the way. The aortic valve is located at the opening from the left side of the heart (left ventricle) into the aorta. The aorta is the big blood vessel that carries blood to all the tissues of the body. The job of the aortic valve is to keep blood moving from the heart into the aorta and to the body. When the heart beats and pushes blood out to the aorta, the valve opens. In between beats, the valve closes so no blood goes back into the heart.

Stenosis is a narrowing of the valve that can make it very difficult for the heart to work properly.

How does it occur?

Some people are born with an abnormal aortic valve in which the valve is partially fused, or stuck together. This prevents normal opening of the valve. In some people, the abnormality is severe at birth and requires treatment at a very young age. In other people, abnormal blood flow through the opening leads to a deposit of calcium in the valve. Over time, this causes the stenosis to get worse. These people may need valve replacement surgery in their 20s, 30s, or 40s.

The most common cause of aortic stenosis is degeneration that occurs with aging. Why this occurs in some people but not in others is not known, but high cholesterol may have something to do with it. It is most common in people over the age of 60. The valve does not open or shut normally, and some backflow or leakage through the valve may occur. Rarely, aortic valve stenosis can be caused by rheumatic fever or some rheumatoid diseases.

What are the symptoms?

With mild stenosis there are usually no symptoms. Aortic valve stenosis usually worsens with time. As the blockage of blood flow from the heart increases, your left ventricle has to work harder. This makes the heart muscle larger and thicker. It may become stiff.

Eventually, the left ventricle can no longer adapt. The first symptom is usually shortness of breath with exertion. With more severe valve blockage, you may have fainting spells. You may also have chest pain.

How is it diagnosed?

Your health care provider will ask about your symptoms and examine you. Your provider will use a stethoscope to hear the distinctive heart murmur caused by the blocked valve. Lab tests help confirm the diagnosis. An electrocardiogram (EKG) will show enlargement and thickening of the heart muscle. You may have an echocardiogram, which uses ultrasound waves to make images of the heart and valves. A special part of the ultrasound test, called the Doppler exam, measures how severe the stenosis is. Chest x-rays and a treadmill exercise test may be needed.

How is it treated?

In the early stages of the disease, you may not need treatment. You will, however, need to take antibiotics before dental work or procedures that involve the rectum, bladder, or vagina. The antibiotics help to prevent infection of the diseased valve. Routine checkups, once or twice a year, are recommended.

See your doctor if you start having symptoms. This is a sign that you may need surgery. In adults, valve replacement surgery is preferred. Children may have surgery to open the fused valve cusps.

Two types of artificial heart valves are available: mechanical and biological.

Mechanical valves work well, but you will need to take blood-thinner medicine for the rest of your life to prevent blood clots. These drugs cause a small increase in the risk of bleeding. You will need to see your provider regularly for check-ups.

Biological valves are made from body tissue. You do not have to take blood thinners, but these valves do not last as long as mechanical valves.

Surgery to replace the aortic valve at the proper time can improve both the quality and the length of life.

How can I take care of myself?

Follow the treatment your health care provider prescribes. In addition:

If you smoke, stop.
Get regular checkups.
With your health care provider's supervision, take antibiotics to prevent infections that could spread to the heart valve if you are having any kind of dental work or surgery, including having your teeth cleaned or procedures involving the bladder, vagina, or rectum. Damaged valves are more likely to become infected by bacteria. Infection of the valve can damage it more and may destroy it. Antibiotics can prevent this. If there is any doubt, be sure to ask if you should take antibiotics.
Lose weight if you are overweight.
Learn ways to reduce or manage stress.
Avoid taking aspirin if you're taking an anticoagulant (blood-thinning drug).
Exercise regularly according to your provider's advice.
Talk to your provider before you use any other medicines, including nonprescription medicines.
Limit the salt in your diet if recommended by your provider.
Ask your provider about a potassium supplement if you're taking diuretics that could cause potassium loss.
Tell all other health care providers you see that you have aortic valve stenosis.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIA File CRD3604F.HTM Release 9.0/2006