Aortic valve stenosis

Ahmed Desouky
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Definition

Aortic valve stenosis — or aortic stenosis — occurs when the heart's aortic valve narrows. The valve
doesn't open fully, which reduces or blocks blood flow from your heart into the main artery to your
body (aorta) and to the rest of your body.

Your treatment depends on the severity of your condition. You may need surgery to repair or replace
the valve. Without treatment, severe aortic valve stenosis can lead to death.

Aortic valve disease

Mayo Clinic cardiologist explains aortic valve disease, including aortic stenosis.
Symptoms
Aortic valve stenosis ranges from mild to severe. Signs and symptoms generally occur when narrowing
of the valve is severe. Some people with aortic valve stenosis may not have symptoms for many years.

Signs and symptoms of aortic valve stenosis may include:

•Abnormal heart sound (heart murmur) heard through a stethoscope

•Chest pain (angina) or tightness with activity

•Feeling faint or dizzy or fainting with activity

•Shortness of breath, especially when you have been active

•Fatigue, especially during times of increased activity

•Rapid, fluttering heartbeat (palpitations)

•Not eating enough (mainly in children with aortic valve stenosis)

•Not gaining enough weight (mainly in children with aortic valve stenosis)

Aortic valve stenosis may lead to heart failure. Heart failure signs and symptoms include fatigue, shortness of
breath, and swollen ankles and feet.
When to see a doctor
If you have a heart murmur, your doctor may recommend that you visit a doctor trained in diseases of the heart
(cardiologist). If you develop any symptoms that may suggest aortic valve stenosis, see your doctor.
Causes
Your heart has four valves that keep blood flowing in the
correct direction. These valves include the mitral valve,
tricuspid valve, pulmonary valve and aortic valve. Each
valve has flaps (cusps or leaflets) that open and close
once during each heartbeat. Sometimes, the valves don't
open or close properly. If a valve doesn't fully open or
close, blood flow is reduced or blocked.
Chambers and valves of the heart
A normal heart has two upper and two lower
In aortic valve stenosis, the aortic valve between the chambers. The upper chambers — the right and left
lower left heart chamber (left ventricle) and the aorta atria — receive incoming blood. The lower
does not open completely. The area through which blood chambers — the right and left ventricles — pump
moves out of the heart to the aorta is narrowed (stenosis). blood out of your heart. The heart valves, which
keep blood flowing in the right direction, are gates
at the chamber openings (for the tricuspid and mitral
valves) and exits (for the pulmonary and aortic
valves).
When the aortic valve opening is narrowed, your heart must work harder to pump enough blood into the
aorta and to the rest of your body.

The extra work of the heart can cause the left ventricle to thicken and enlarge. Eventually the strain can
cause a weakened heart muscle and can ultimately lead to heart failure and other serious problems.

Aortic valve stenosis

In aortic valve stenosis, the aortic valve opening is
narrowed (top row). The narrowing requires increased
pressure within the heart to pump blood across a smaller
opening. Eventually this reduces the heart's ability to
pump blood to the body. This is similar to attaching
smaller and smaller nozzles to the end of a garden hose
(bottom row). The narrowing from the nozzle slows the
forward flow of water and results in pressure buildup
within the garden hose.
Aortic valve stenosis causes include:

•Congenital heart defect. Some children are born with an aortic valve that has only two cusps (bicuspid
aortic valve) instead of three (tricuspid aortic valve). Rarely, an aortic valve may have one (unicuspid) or four
(quadricuspid) cusps.
•Having a congenital heart defect such as a bicuspid aortic valve requires regular checkups by a doctor. The
valve defect may not cause any problems until adulthood. If the valve begins to narrow or leak, it may need to
be repaired or replaced.
Aortic valve stenosis
Aortic valve stenosis is a defect that narrows or
obstructs the aortic valve opening, making it
difficult for the heart to pump blood into the body's
main artery (aorta). Typically the aortic valve has
three tightly fitting, triangular-shaped flaps of
tissue called cusps (tricuspid aortic valve).
However, some people are born with an aortic
valve that has two cusps (bicuspid aortic valve).
•Calcium buildup on the valve. Calcium is a mineral
found in your blood. As blood repeatedly flows over the
aortic valve, calcium deposits can build up on the heart
valves (aortic valve calcification).
•The calcium deposits may never cause any problems.
Aortic valve stenosis that's related to increasing age and
calcium deposit buildup usually doesn't cause symptoms
until ages 70 or 80. However, in some people —
particularly those with a congenital aortic valve defect —
calcium deposits result in stiffening of the valve cusps at
a younger age.
•Heart valve calcium deposits aren't linked to taking
calcium tablets or drinking calcium-fortified products.

•Rheumatic fever. This complication of strep throat infection

may result in scar tissue forming on the aortic valve. Scar tissue
can narrow the aortic valve opening or create a rough surface on
which calcium deposits can collect.
•Rheumatic fever may damage more than one heart valve, and in
more than one way. While rheumatic fever is rare in the United
States, some older adults had rheumatic fever as children.t
Risk factors
Risk factors of aortic valve stenosis include:

•Older age

•Certain heart conditions present at birth (congenital heart

disease) such as a bicuspid aortic valve

•History of infections that can affect the heart

•Having cardiovascular risk factors, such as diabetes,

high cholesterol and high blood pressure

•Chronic kidney disease

•History of radiation therapy to the chest

Complications

Aortic valve stenosis can cause complications, including:

•Heart failure

•Stroke

•Blood clots

•Bleeding

•Heart rhythm problems (arrhythmias)

•Infections that affect the heart, such as endocarditis

•Death
Tests are Used to Diagnose for Aortic
Stenosis
Auscultation: Your cardiologist will use a stethoscope to listen to the sounds of your
heart.
Electrocardiogram (ECG): Sensors are attached to your skin to measure the electrical
impulses given off by your heart, displayed as waves on a monitor or printed on paper.

Chest X-ray: An X-ray Image of your chest allows your doctor to check the size and
shape of your heart. A chest X-ray can also reveal calcium deposits on the aortic valve.

Echocardiogram: This is also known as an ultrasound; it uses sound waves to produce

an image of your heart, which helps your doctor closely examine the aortic valve.

Cardiac Catheterization: In this test, a dye is injected into your heart through your arm
or groin to make you heart more visible on an X-ray.
Treatment
Treatment for aortic stenosis depends on how far yourdisaes has progressed. If you stenosis is mild,
medication may be prescribed to help regulate your heartbeat and prevent blood clots. However, if the
severity of your stenosis progresses, it may be recommended that the diseased aortic valve needs to be
replaced. Severe aortic stenosis cannot be treated with medication. The only effective treatment is to
replace your aortic valve.

Today there are two options to replace your diseased aortic valve.

• Transcatheter Aortic Valve Implantation (TAVI)

• Open Heart Surgical Aortic Valve Replacement

Prevention
Some possible ways to prevent aortic valve stenosis include:
•Taking steps to prevent rheumatic fever. You can do this by making sure
that you see your doctor when you have a sore throat. Untreated strep throat
can develop into rheumatic fever. Fortunately, strep throat can usually be easily
treated with antibiotics. Rheumatic fever is more common in children and
young adults.
•Addressing risk factors for coronary artery disease. These include high
blood pressure, obesity and high cholesterol levels. These factors may be
linked to aortic valve stenosis, so it's a good idea to keep your weight, blood
pressure and cholesterol levels under control if you have aortic valve stenosis.
•Taking care of your teeth and gums. There may be a link between infected
gums (gingivitis) and infected heart tissue (endocarditis). Inflammation of
heart tissue caused by infection can narrow arteries and aggravate aortic valve
stenosis.

Once you know that you have aortic valve stenosis, your doctor may recommend that you
limit strenuous activity to avoid overworking your heart.
Thank You!