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Aortic Valve Disease

 

What is aortic valve disease?

Aortic valve disease is a type of heart valve disease where the valve between the lower left chamber of the heart and the body’s main artery, called the aorta, does not work properly. The aorta is responsible for pushing blood from the heart to the rest of the body. With aortic valve disease, the affected valve can affect blood flow the rest of the body, causing many complications.

In some cases, a person can be born with aortic valve disease, also called a congenital heart defect. In other cases, aortic valve disease is developed later in life due to certain health conditions. 

Aortic valve disease includes:

  • Aortic valve stenosis – our hearts valves have flaps of tissue, called cusps, that open and close once per heartbeat. If these cusps become thick and stiff or grow together, the opening to the valve becomes narrow, reducing or blocking blood flow from the heart to the rest of the body.
  • Aortic value regurgitation – occurs when the aortic value does not close properly, causing blood to flow backward into the lower left heart chamber.

What causes aortic valve disease?

In some cases, a person can be born with aortic valve disease, called a congenital heart defect. 

Other causes can include:

  • Changes to the heart due to aging
  • Infections
  • High blood pressure
  • Injury to the heart

Many things can contribute to the development of aortic valve disease, including:

  • Calcium can build up on the aortic valve as people age, causing the aortic valve to stiffen and become narrow.
  • Congenital heart defects that are present at birth increase the risk of aortic valve regurgitation. This can include a missing, extra or fused valve flap.
  • Rheumatic fever is a complication of strep throat throat that can cause aortic stenosis.
  • Endocarditis is the inflammation of the lining of the heart’s chambers and valves. This life-threatening condition is usually caused by infection of the heart.
  • Radiation therapy to treat certain types of cancer can be a risk factor for developing aortic valve disease, although it is often not noticed until many years after treatment is complete.
  • Other chronic health conditions, such as chronic kidney disease, lupus and connective tissue disorders can increase your risk of developing aortic valve disease.

What are the symptoms of aortic valve disease?

In many cases, people who have developed aortic valve disease do not even know until many years later – either during a routine exam or when symptoms start to arise.

Common symptoms may include:

  • Chest pain or tightness
  • Dizziness
  • Fainting
  • Fatigue after activity
  • Irregular heartbeat
  • Shortness of breath

In children who have aortic valve disease, you may notice that they do not eat enough or have problems gaining weight. This is common with children with aortic valve stenosis.

What are the complications of aortic valve disease?

Since symptoms of aortic valve disease sometimes don’t present themselves until long after you have developed the disease, it can be hard to know when to seek medical attention for symptoms that can mean other things. If you begin to experience symptoms consistent with aortic valve disease such a shortness of breath, fatigue after activity or a pounding heartbeat, contact your healthcare provider. These symptoms, along with sudden chest pain, can be signs of a medical emergency, so seek medical attention right away. 

Potential complications from aortic valve disease can include:

  • Blood clots
  • Stroke
  • Heart failure
  • Heart rhythm problems
  • Death due to sudden cardiac arrest.

How is aortic valve disease diagnosed?

To diagnose aortic valve disease, your provider will perform a physical examination and review your medical history. During their exam, they will listen for a heart murmur, which sounds like a whooshing sound. If they suspect potential aortic valve disease, additional tests may be needed, including:

  • Echocardiogram – uses sound waves to create pictures of your beating heart to show how blood is flowing through the heart and heart valves. This can help to determine the severity of the aortic valve disease.
  • Electrocardiogram – records the electrical activity of the heart to determine how fast the heart beats.
  • Chest X-ray – can help to determine if the heart is enlarged through pictures.
  • Cardiac MRI – creates detailed pictures of the heart to determine the severity of aortic valve disease and measure the size of the aorta.
  • CT scan – measures the size of the aorta and looks at the aortic valve more closely. It can also measure the amount of calcium in the aortic valve and determine the severity of aortic valve stenosis.
  • Exercise test – shows how the heart reacts to physical activity and whether you show symptoms during exercise.

After your provider has reviewed the results of your tests, they will use this information to confirm the diagnosis and the stage of your disease. Staging will help your provider determine the best course of treatment. 

Heart valve disease is staged into 4 groups, depending on symptoms, severity, structure of the aorta and blood flow through the heart and lungs. These groups include:

  • Stage A: “At risk” – risk factors for heart valve disease are present.
  • Stage B: “Progressive” – valve disease is mild or moderate, but no heart valve symptoms.
  • Stage C: “Asymptomatic severe” – no heart valve symptoms but the valve disease is severe.
  • Stage D: “Symptomatic severe” – heart valve disease is severe and is causing symptoms.

What are the treatment options for aortic valve disease?

Treatment aortic valve disease will vary depending on the stage your provider determines. Aortic valve disease does not always require invasive treatments. In mild or moderate cases or if you aren’t having symptoms, treatment can include regular health checkups, lifestyle changes and medications to treat symptoms and reduce the risk of complications. These medications may be used to lower blood pressure, prevent irregular heartbeats, and remove excess fluid from the body.

In more severe cases, a surgery or catheter procedure may be needed to repair or replace the diseased aortic valve. These can include:

Aortic Valve Repair

In an aortic valve repair, your surgeon may:

  • Separate valve flaps that have fused
  • Add support to the base of the valve
  • Reshape or remove excess valve tissue so the cusps can close tightly
  • Patch holes or tears in a valve

Balloon Valvuloplasty

A balloon valvuloplasty is a type of aortic valve repair that is most commonly done in infants and children as it is a less invasive procedure. During this procedure, the surgeon inserts a hollow tube into the blood vessel and threads it to the heart. Then, the balloon is inflated to widen the valve opening. Then, the balloon is deflated and removed.

Aortic Valve Replacement

In an aortic valve replacement, the surgeon removes the damaged valve and replaces it with a mechanical valve or biological tissue valve, often sourced from a cow, pig, or human heart tissue. In some cases, the valve may be replaced with your own lung valve, called a pulmonary valve.

What are the risk factors of aortic valve disease treatment?

As with any procedure, treating aortic valve disease carries certain risks, which may include:

  • Irregular heartbeat
  • Bleeding
  • Blood clots
  • Damage to tissues
  • Infection
  • Heart failure resulting in death