Aortic valve disease is a condition in which the valve between the main pumping chamber of your heart (left ventricle) and the main artery to your body (aorta) doesn't work properly. Aortic valve disease may be a condition present at birth (congenital heart disease), or it may result from other causes.
Types of aortic valve disease include:
In this condition, the flaps (cusps) of the aortic valve may become thickened and stiff, or they may fuse together. This causes narrowing of the aortic valve opening. The narrowed valve isn't able to open fully, which reduces or blocks blood flow from your heart into your aorta and the rest of your body.
In this condition, the aortic valve doesn't close properly, causing blood to flow backward into the left ventricle.
Your treatment depends on the type and severity of your aortic valve disease. In some cases you may need surgery to repair or replace the aortic valve.
Some people with aortic valve disease may not experience symptoms for many years. Signs and symptoms of aortic valve disease may include:
If you have a heart murmur, your doctor may recommend that you visit a cardiologist or have a test called an echocardiogram (ultrasound of the heart). If you develop any symptoms that may suggest aortic valve disease, see your doctor.
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, disrupting the blood flow through your heart and potentially impairing the ability to pump blood to your body.
In aortic valve disease, the aortic valve between the lower left heart chamber (left ventricle) and the main artery that delivers blood from the heart to the body (aorta) doesn't work properly. It may not be closing properly, which causes blood to leak backward to the left ventricle (regurgitation), or the valve may be narrowed (stenosis).
Aortic valve disease may be caused by a heart defect present at birth (congenital). It can also be caused by other conditions, including age-related changes to the heart, infections, high blood pressure or injury to the heart.
Risk factors of aortic valve disease include:
Aortic valve disease can cause complications, including:
To diagnose aortic valve disease, your doctor may review your signs and symptoms, discuss your medical history, and conduct a physical examination. Your doctor may listen to your heart with a stethoscope to determine if you have a heart murmur that may indicate an aortic valve condition. A doctor trained in heart disease (cardiologist) may evaluate you.
Your doctor may order several tests to diagnose your condition, including:
Echocardiogram. This test uses sound waves to provide video images of your heart in motion. During this test, specialists hold a wandlike device (transducer) on your chest. Doctors may use this test to evaluate your heart chambers, the aortic valve and the blood flow through your heart.
This test can help doctors closely look at the condition of the aortic valve, and the cause and severity of your condition. It can also help doctors determine if you have additional heart valve conditions. Doctors may also use a 3D echocardiogram.
Doctors may conduct another type of echocardiogram called a transesophageal echocardiogram to get a closer look at the aortic valve. In this test, a small transducer attached to the end of a tube is inserted down the tube leading from your mouth to your stomach (esophagus).
Cardiac catheterization. This test isn't often used to diagnose aortic valve disease, but it may be used if other tests aren't able to diagnose the condition or to determine its severity.
In this procedure, a doctor threads a thin tube (catheter) through a blood vessel in your arm or groin to an artery in your heart and injects dye through the catheter to make the artery visible on an X-ray. This provides your doctor with a detailed picture of your heart arteries and how your heart functions. It can also measure the pressure inside the heart chambers to help in the evaluation of aortic valve disease.
Treatment for aortic valve disease depends on the severity of your condition, whether or not you're experiencing signs and symptoms, and if your condition is getting worse.
If your aortic valve disease is mild or moderate or you aren't experiencing symptoms, your doctor may monitor your condition with regular follow-up appointments. Your doctor may recommend you make healthy lifestyle changes and take medications to treat symptoms or reduce the risk of complications.
You may eventually need surgery or another procedure to repair or replace the diseased aortic valve. In some cases, your doctor may recommend surgery even if you aren't experiencing symptoms. If you're having another heart surgery, doctors may perform aortic valve surgery at the same time.
If you have aortic valve disease, consider being evaluated and treated at a medical center with a multidisciplinary team of cardiologists and other doctors and medical staff trained and experienced in evaluating and treating heart valve disease. This team can work closely with you to determine the most appropriate treatment for your condition.
Surgery to repair or replace an aortic valve is usually performed through a cut (incision) in the chest. In some cases, doctors may perform minimally invasive heart surgery, which involves the use of smaller incisions than those used in open-heart surgery.
Surgery options include:
To repair an aortic valve, surgeons may conduct several different types of repair, including separating valve flaps (cusps) that have fused, removing excess valve tissue so that the cusps can close tightly or patching holes in a valve.
Doctors may conduct a procedure using a long, thin tube (catheter) to open up a valve with a narrowed opening (aortic valve stenosis). In this procedure, called balloon valvuloplasty, a doctor inserts a catheter with a balloon on the tip into an artery in your groin and guides it to the aortic valve. A doctor then inflates the balloon, which expands the opening of the valve. The balloon is then deflated, and the catheter and balloon are removed.
The procedure can treat aortic valve stenosis in infants and children. However, the valve tends to narrow again in adults who've had the procedure, so it's usually only performed in adults who are too ill for surgery or who are waiting for a valve replacement, as they typically need additional procedures to treat the narrowed valve over time.
Doctors may also use a catheter procedure to insert a plug or device to repair a leak around a replaced aortic valve.
Aortic valve replacement is often needed to treat aortic valve disease. In aortic valve replacement, your surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve). Another type of biological tissue valve replacement that uses your own pulmonary valve is sometimes possible.
Biological tissue valves degenerate over time and may eventually need to be replaced. People with mechanical valves will need to take blood-thinning medications for life to prevent blood clots. Your doctor will discuss with you the benefits and risks of each type of valve and discuss which valve may be appropriate for you.
Doctors may perform a less invasive procedure called transcatheter aortic valve replacement (TAVR) to replace a narrowed aortic valve. TAVR may be an option for people who are considered to be at increased risk of complications from surgical aortic valve replacement.
In TAVR, doctors insert a catheter in your leg or chest and guide it to your heart. A replacement valve is then inserted through the catheter and guided to your heart. A balloon may expand the valve, or some valves can self-expand. When the valve is implanted, doctors remove the catheter from your blood vessel.
Doctors may also conduct a catheter procedure to insert a replacement valve into a failing biological tissue valve that is no longer working properly. Other catheter procedures to repair or replace aortic valves continue to be researched.
You'll have regular follow-up appointments with your doctor to monitor your condition.
Your doctor may suggest you incorporate several heart-healthy lifestyle changes into your life, including:
For women with aortic valve disease, it's important to talk with your doctor before you become pregnant. Your doctor can discuss with you which medications you can safely take, and whether you may need a procedure to treat your valve condition prior to pregnancy.
You'll likely require close monitoring by your doctor during pregnancy. Doctors may recommend that women with severe valve conditions avoid pregnancy to avoid the risk of complications.
If you have aortic valve disease, here are some steps that may help you cope:
If you think you have aortic valve disease, make an appointment to see your doctor. Here's some information to help you prepare for your appointment.
For aortic valve disease, some basic questions to ask your doctor include:
Don't hesitate to ask other questions you have.
Your doctor is likely to ask you a number of questions, including:
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