Definition

The aortic valve is located between the left ventricle of the heart and the aorta, which is the largest artery in the body. The aorta supplies blood throughout the body. Aortic stenosis (AS) is a narrowing of the aortic valve that could block blood flow from the heart and cause a back-up of flow and pressure in the heart and to the lungs. AS can range from mild to severe.

Causes

The main causes of AS include:

• A birth defect of the aortic valve, which normally has three cusps:
  • A two-part aortic valve becomes stenotic with progressive wear and tear
  • An aortic valve that has only one cusp or has stenosis from birth
• Progressive hardening and calcification of the aortic valve with age
• Scarring of the aortic valve caused by rheumatic fever—rare

Risk Factors

Factors that may increase the risk of AS include:

• Gender: male
• Family members with heart disease that affects the valves
• History of rheumatic fever
• Hypertension
• Hypercholesterolemia
• Diabetes mellitus
• Smoking

Symptoms

AS does not always produce symptoms. But if symptoms do occur, they may include:

• Extreme fatigue after exercise or exertion
• Fainting with exercise or exertion
• Pain, squeezing, pressure, or tightness of the chest usually occurring with exertion
• Rapid or irregular heartbeat
• Shortness of breath
• Lightheadedness with exertion
• Neurological symptoms of a stroke or transient ischemic attack

In rare cases, AS can cause abnormal heart rhythms known as arrhythmia, or sudden death with no previous symptoms.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor may be alerted to AS by the following:

• Abnormal chest sounds such as a heart murmur or clicking sound
• Noticeable chest heave or vibration when the doctor's hand is held over your heart

Images may need to be taken of your chest. This can be done with:

• Chest x-ray
• Electrocardiogram
• Echocardiogram
• Cardiac catheterization

Treatment

If you have mild AS, your condition will be monitored, but may not need immediate treatment. If you have more severe AS, your doctor may advise you to avoid strenuous physical activity. If necessary, you may be given medicines to help prevent heart failure. If needed, you may be prescribed medicine, and surgery may be required.

Surgery

Surgical options include:

• Balloon valvuloplasty —A balloon device is passed through the arteries to open or enlarge the stenotic aortic valve. This may provide temporary relief of symptoms. But since the valve can become blocked again, this treatment is not a permanent solution.
• Aortic valve replacement —During this open surgery, the defective heart valve is replaced with either a bioprosthetic valve or a synthetic valve.
• Transcatheter aortic valve replacement—This surgery also involves replacing the defective valve. But this is minimally invasive surgery that involves inserting the replacement valve through a small incision in the chest or through an artery in the leg.

Aortic Valve Replacement—Mechanical and Bioprosthetic Valve Shown

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Prevention

AS cannot be prevented. But if you have AS, there are several things you can do to try to avoid some of the complications, such as:

• Get regular medical care, including exams and tests.
• Only certain people with AS need antibiotics before dental or medical procedures. Ask your doctor if you need antibiotics to prevent infection of the heart valve.