Aortic Valve disease

The human heart has four valves—two on the left and two on the right. The aortic valve—the main outflow valve for the left heart—is the valve between the heart and the body. The aortic valve opens when the left ventricle squeezes to pump out blood, and closes in between heart beats to keep blood from going backward into the heart.

Normally, the aortic valve has three flaps (leaflets) that regulate blood flow by opening and closing, allowing blood to flow throughout your body.

Aortic valve disease occurs when the aortic valve doesn’t work properly; it either fails to close tightly (aortic regurgitation or insufficiency) or gets too tight (aortic stenosis).

TYPES OF AORTIC VALVE DISEASE

In a healthy aortic valve, valve leaflets open wide to let blood through and close tightly to keep it from going backward. The valve leaflets are thin and pliable.

There are two main types of aortic valve disease:

  1. Aortic Regurgitation (also known as aortic insufficiency) — the valve does not close completely, allowing blood to leak backward into the heart
  2. Aortic Stenosis — the valve is too tight and does not open enough to allow blood to leave the heart and spread to the body

CAUSES AND SYMPTOMS

The aortic valve may be abnormal from birth (congenital), or it could become diseased with age (acquired).

The most common congenital aortic valve abnormality, called a bicuspid aortic valve, occurs when the valve has only two leaflets (bicuspid) instead of three (tricuspid). This prevents the valve from opening or closing completely. Although the abnormality has been there since birth, symptoms may not be felt until adulthood. Your physician may be able to hear distinctive murmurs (abnormal sounds that can be heard with a stethoscope) when listening to your heart.

Acquired aortic valve disease occurs because your valve simply wears out over time, and usually happens as you age. Calcium collects on the valve and can cause the leaflets to stiffen and narrow, which limits their motion.

If the aorta—the main blood vessel coming out of the heart—is diseased, this also can lead to problems with the aortic valve.

A faulty or failing aortic valve may cause symptoms such as shortness of breath, chest pain, and dizziness or loss of consciousness (passing out). These symptoms are due to the heart having to work harder because of the narrowed or leaky valve.

Early on, these symptoms may be noticeable only when exercising, but as the disease progresses, you could experience shortness of breath with minimal or no activity.

Some patients will be unable to sleep flat in bed or may awaken short of breath. Another potential symptom is swollen feet, particularly in the late afternoon or early evening.

Your doctor can usually diagnose aortic valve disease based on your medical history, risk factors, a physical exam, and with results from tests and procedures.

DIAGNOSIS AND TREATMENT OPTIONS

There is no one test that can diagnose aortic valve disease, so your doctor may recommend one or more of the following: electrocardiogram (EKG), echocardiogram (echo), chest x-ray, blood tests, and coronary angiography. For more information on these tests, visit our common diagnostic tests page.

Currently, NO MEDICATION can cure aortic valve disease, so it is most commonly treated with surgery.

Aortic stenosis can only be treated with aortic valve replacement. Sometimes, aortic valves that are leaking (regurgitant) can be repaired. Your Heart Team—you, your medical team, and your cardiothoracic surgeon—will determine the best treatment option for you based on your symptoms and test results. You can print these sample questions to use as a basis for discussion with your doctor.

You also can access the STS Risk Calculator, which can help calculate your risk of death or other complications from open heart surgery. The results can help you and your doctor to determine the best course of treatment.

SURGICAL TREATMENT OPTIONS FOR AORTIC VALVE DISEASE

Surgical Aortic Valve Replacement

Surgical aortic valve replacement (SAVR), performed by a cardiothoracic surgeon, involves making an incision in the chest in order to get to the heart and aortic valve. The heart is stopped.

   

Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) is a form of minimally invasive surgery that does not require opening the breastbone. It is used to treat aortic stenosis.

   

Aortic Valve Repair

While the aortic valve is usually replaced, repair may be an option in certain cases.

Minimally invasive AVR is not appropriate for all patients, but your cardiothoracic surgeon will review the recommended approach to surgery that is safest for you based on your individual symptoms and circumstances.

RECOVERY

Most aortic valve surgeries have a very low rate of complications; however, potential complications of all surgical options include bleeding, infection, irregular heart rhythm, need for a pacemaker, stroke, heart attack, or death.

Immediately after AVR surgery, you likely will have a tube in your throat so your breathing can be assisted by a ventilator.

The tube will be removed once you are able to breathe on your own. This usually happens within a few hours, but your cardiothoracic surgeon and Heart Team will determine when it is safe. You should anticipate spending several days, but likely not more than a week, recovering in the hospital, although the total length of time depends on your overall health, as well as the specific procedure you underwent.

Once you’re home, it may be several more weeks until you are able to go back to work. Everyday activities such as driving and lifting heavy objects may be restricted for a period of time. Typically, lifting and activity restrictions are 4-6 weeks for traditional AVR and 1-2 weeks for TAVR.

Blood thinning medication may be prescribed after surgery, but your need for this medication will be determined by your doctor.

After your wounds have healed, you should be able to get back to your normal activities. Always tell a doctor about your valve surgery before any medical procedure. In particular, you may require preventative antibiotics when having dental work.

 

Reviewed by: V. Seenu Reddy, MD, MBA, and Kendra J. Grubb, MD, MHA
June 2018