Aortic Valve Stenosis (Aortic Stenosis)

Causes of aortic valve stenosis

Conditions that could cause aortic valve stenosis include:

• Congenital heart defect — aortic stenosis can form during early fetal development.
• Rheumatic fever — caused by untreated strep throat, can cause narrowing in the aortic valve.
• Calcium build-ups — if the aortic valve does not grow as a person ages, the heart must work harder to pump blood in the narrowed opening. As calcium builds on the valve, it can become stiffer and narrower.

Risk factors for aortic valve stenosis

There are several factors that could contribute to the development of aortic valve stenosis.

• Age — older patients are more likely to develop aortic valve stenosis.
• Congenital heart disease — if you have another heart valve condition present at birth, such as a bicuspid valve, you are more likely to also have aortic valve stenosis.
• Cardiovascular risk factors — if you have cardiovascular risk factors such as hypertension, high cholesterol or diabetes, you are at greater risk for developing aortic valve stenosis.

Symptoms of aortic valve stenosis

Many people have aortic stenosis for years before realizing they have the condition. Symptoms commonly occur during exercise.

The most common symptoms of aortic valve stenosis include:

• Angina (chest pain)
• Fainting
• Shortness of breath
• Dizziness or fainting
• Heart palpitations

Diagnosis of aortic valve stenosis

To diagnose aortic valve stenosis, your cardiologist will take a full medical history, discuss symptoms, conduct a physical exam and listen for a heart murmur.

To confirm the diagnosis, the doctor may order diagnostic tests including:

• Doppler echocardiogram — a diagnostic test that uses ultrasound technology to detect the direction and velocity of blood flow in the heart.
• Electrocardiogram — will be able to determine if your heart chambers are enlarged or if you have abnormal heart rhythms or other heart disease.
• Chest x-ray — can take pictures of the heart to determine if the heart or aorta is enlarged or if you have calcium buildup on the aortic valve.
• Exercise stress test (stress test) — can determine the severity of your aortic stenosis by evaluating your symptoms under stress (physical activity).
• Cardiac computerized tomography (CT) scan — can provide more detailed images of your heart and heart valves.
• Cardiac magnetic resonance imaging (MRI) — will take detailed photos of the heart to measure the size of the aorta and determine the stage of aortic stenosis you are in.

Treatment for aortic valve stenosis

Treatment for aortic stenosis depends on the severity of your symptoms as well as the progression of the disease. If you are not experiencing symptoms, your doctor may propose regular monitoring, recommend healthy lifestyle changes or prescribe medications.

When symptoms become severe, surgery may be necessary to repair or replace the aortic valve.

Surgical options to treat aortic stenosis include:

Balloon valvuloplasty

During a balloon valvuloplasty, a catheter is inserted and threaded to the aortic valve. Once in the correct position, the surgeon will inflate a balloon to widen the valve opening.

Balloon valvuloplasty is most effective in children and infants and typically only used in adults when they are too ill for surgery or if they are waiting on a valve replacement. If you had a balloon valvuloplasty as a child, the aortic valve may need to be repaired again as an adult.

Aortic valve replacement

During an aortic valve replacement procedure, your cardiothoracic surgeon will remove the diseased aortic valve and replace it with a biological tissue or mechanical valve. A biological tissue valve is a valve made from human, cow or pig heart tissue.

There are risks and benefits to both mechanical and tissue valves. Your doctor will evaluate your case and determine the most appropriate type of valve for you.

Surgical aortic valve replacement is an open-heart surgery and is not appropriate for every patient. Elderly and severely ill patients may need alternative treatments.

Transcatheter aortic valve replacement (TAVR)

Some patients may be candidates for a minimally invasive, aortic valve replacement surgery called transcatheter aortic valve replacement or TAVR. TAVR is an option for patients who are at risk for complications from surgical valve replacement.

During a TAVR procedure, a catheter is threaded into the heart (through the groin or chest) and the replacement valve is inserted and expanded. TAVR is less invasive and requires less recovery time than surgical aortic valve replacement.