Illness & Conditions - Special Health Issues
Aortic Valve Stenosis
What is aortic valve stenosis?
Aortic valve stenosis is a narrowing of the aortic valve . The aortic valve allows blood to flow from the heart's lower left chamber (ventricle) into the aorta and to the body. Stenosis prevents the valve from opening properly, forcing the heart to work harder to pump blood through the valve. This causes pressure to build up in the left ventricle and thickens the heart muscle.
Your heart can make up for aortic valve stenosis and the extra pressure for a long time. But at some point, it won't be able to keep up the extra effort of pumping blood through the narrowed valve. This can lead to heart failure .
What causes aortic valve stenosis?
Problems that can cause aortic valve stenosis include:
What are the symptoms?
Aortic valve stenosis is a slow process. For many years, even decades, you will not feel any symptoms. But at some point, the valve will likely become so narrow (often one-fourth of its normal size) that you start having problems. Symptoms are often brought on by exercise, when the heart has to work harder.
As aortic valve stenosis gets worse, you may have symptoms such as:
If you start to notice any of these symptoms, let your doctor know right away. If you have symptoms, you need treatment. By the time you have symptoms, your condition probably is serious. If you have symptoms, you also have a high risk of sudden death.
How is aortic valve stenosis diagnosed?
Most people find out they have it when their doctor hears a heart murmur during a regular physical exam. To be sure of the diagnosis, your doctor may want you to have an echocardiogram , which can show moving pictures of your heart. You may have other tests to help your doctor judge how well your heart is working.
How is it treated?
If you don't have symptoms, your doctor will see you regularly to check your heart. You probably will not have surgery. Unless you have symptoms, or tests show that the heart's pumping action is getting weak, surgery is likely to be more risky than the disease.
If you have symptoms, you probably need surgery right away. Surgery to replace the aortic valve is the best treatment for most people. View a slideshow on aortic valve replacement surgery . Some young people or people who cannot have open-heart surgery may have another procedure called balloon valvuloplasty to enlarge the valve opening.
If you don't have surgery after you start having symptoms, you may die suddenly or develop heart failure. Surgery can help you have a more normal life span.
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Frequently Asked Questions
Most people who have aortic valve stenosis are born with a normal, healthy aortic valve but develop aortic stenosis late in life. Aging and calcium buildup cause the leaflets of the valve to thicken and harden, preventing the valve from opening properly. Typically, stenosis develops slowly over many years.
Some people may develop aortic stenosis after having rheumatic fever as a child. It usually takes 30 to 40 years after a case of rheumatic fever for aortic stenosis to develop. Rheumatic fever has been rare in the United States since the 1970s.
You probably won't have any symptoms if you have mild or moderate aortic valve stenosis, because your heart can make up for the stenosis. You may begin to notice symptoms if the pressure buildup in the heart becomes severe or if blood flow to the heart and the rest of the body is reduced. You may have symptoms when you exercise or do something strenuous, because your heart has to work harder.
Symptoms may include:
What Increases Your Risk
Certain medical problems or conditions make it more likely that you will develop aortic valve stenosis:
Other things that increase the risk for aortic valve stenosis include:
When to Call a Doctor
Call your doctor immediately if you have any of the symptoms of aortic valve stenosis , such as:
Who to see
Your family doctor may diagnose aortic valve stenosis during a routine checkup. Other health professionals who also may discover aortic valve stenosis during a physical exam include:
Exams and Tests
A physical exam and review of your medical history are important first steps in diagnosing aortic valve stenosis. If you have stenosis but no symptoms, your doctor will likely find the condition during a routine exam or a checkup for another health problem. A distinctive heart murmur is usually the first clue that leads a doctor to suspect aortic valve stenosis.
During the physical exam, the doctor will:
An echocardiogram (echo) can confirm your symptoms and tell your doctor how severe stenosis is, how well your left ventricle is working, and whether there are problems with other valves.
It's also an important test to help monitor aortic valve stenosis over time.
Other tests for aortic valve stenosis
Treatment for aortic valve stenosis usually depends on whether you have symptoms.
If you have symptoms, surgery to replace the aortic valve is usually required. If you don't have your valve replaced after you start having symptoms, you may die suddenly or develop heart failure. Valve replacement can help you have a more normal life span.
Balloon valvuloplasty is a less invasive procedure that might be done for some children, teens, or young adults in their 20s, or for people for whom valve surgery is too great a risk. For more information, see Surgery.
People who have symptoms of aortic valve stenosis have a high risk of sudden death. On average, people may die within 2 to 3 years if they don't have valve replacement surgery. 1 So it is important to consider end-of-life issues.
If you choose not to have surgery, your doctor will prescribe medicines to make you comfortable. As you get sicker, you may be unable to make decisions about your medical care. You may want to consider the type of care you wish to receive in case you are unable to make your wishes known. For more information, see the topic Care at the End of Life.
Living With Aortic Valve Stenosis
How you will feel and how aortic valve stenosis will affect your life will vary greatly depending on whether you have symptoms and the treatment decisions you make.
If you have no symptoms
If you have symptoms
For more help, see the topic Heart Failure.
Medicines aren't used to treat aortic valve stenosis . But you may need medicines to prevent and treat complications from the condition. Or you may need to take medicines if you have valve replacement surgery.
If you have valve replacement surgery, you may need:
Your doctor will likely recommend valve replacement surgery if you have symptoms of aortic valve stenosis, unless you have other health problems that make surgery too risky. Most of the time, valve replacement surgery has a high rate of success and a low risk of causing other problems.
Balloon valvuloplasty is a less invasive procedure than surgery. It may be an option for some younger people who have aortic valve stenosis. This procedure might be done in older adults who cannot have valve replacement surgery. Although the heart valve is not replaced, the narrowed opening is made larger.
Aortic valve replacement surgery
Aortic valve replacement surgery is either an open-heart surgery or a minimally invasive surgery. In an aortic valve replacement surgery, the damaged valve is removed and replaced with an artificial valve (mechanical or tissue).
View a slideshow on aortic valve replacement surgery . To learn more about this decision, see:
If you decide to have surgery, you and your doctor will decide which type of valve is right for you. For help with this decision, see:
Bypass surgery with valve replacement surgery
If you are going to have valve replacement surgery, your doctor may suggest that you have a coronary angiogram/catheterization test. This test can show if you have blockages in your coronary arteries (as part of coronary artery disease). If you have serious blockages, your doctor may want to do a coronary artery bypass surgery at the same time as the valve replacement surgery. For more information, see Aortic Valve Stenosis: Treatment with Other Heart Diseases.
Transcatheter aortic valve replacement
Transcatheter aortic valve replacement is a new way to replace an aortic valve. It does not require open-heart surgery. It is a minimally invasive procedure that uses catheters in blood vessels to replace the aortic valve with a specially designed artificial valve. The catheters are inserted through small cuts in the groin.
This procedure is available in a small number of hospitals. And it is not right for everyone. It might be done for a person who cannot have surgery to replace his or her valve. For example, it might be an option if you are not healthy enough for an open-heart surgery. Although this procedure is minimally invasive, it has serious risks including stroke, kidney problems, and death. 2
Other Places To Get Help
Last Revised: November 2, 2011
Bonow RO, et al. (2008). 2008 Focused update incorporated into the ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 Guidelines for the management of patients with valvular heart disease). Circulation, 118(15):
Holmes DR Jr, et al. (2012). 2012 ACCF/AATS/SCAI/STS Expert consensus document on transcatheter aortic valve replacement. Journal of the American College of Cardiology. Published online January 31, 2012 (doi:10.1016/j.jacc.2012.01.001).
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