Aortic Valve Disease

Aortic valve disease is an umbrella term for conditions that affect your aortic valve. This valve is like a door. It manages blood flow from your heart’s main pumping chamber (left ventricle) into a large artery called your aorta. Your aortic valve is supposed to open and close completely to help keep your heart working normally. If it has trouble doing either or both, you have this condition.

There are two main types of aortic valve disease:

• Aortic valve stenosis: Your valve opening is narrowed or blocked. So, less blood can go through.
• Aortic valve regurgitation: Your valve doesn’t close tightly and is “leaky.” This means some blood goes back the wrong way each time your heart beats.

It’s also possible to have mixed aortic valve disease. This means your aortic valve is both narrowed and leaky.

Aortic valve disease is the most common form of heart valve disease in developed nations. It’s also the most dangerous, causing more deaths than any other type of valve disease in the U.S. Early diagnosis and treatment can be lifesaving.

Symptoms of aortic valve disease

Early on, you may have no symptoms. As aortic valve disease gets worse, you may experience:

• Chest pain or discomfort
• Dizziness
• Fainting
• Fatigue
• Heart palpitations
• Shortness of breath with exertion, when lying down or when sleeping
• Swelling in your feet and ankles

Aortic valve disease causes

The most common cause of aortic valve disease is wear and tear from aging. Your valve works hard over the years and eventually starts to break down. Plus, as you get older, calcium can build up on your valve flaps (leaflets). Over time, the calcium makes the flaps grow thick and stiff so they can’t open and shut properly. This is called calcific aortic valve disease, or aortic valve calcification.

Besides aging, other causes include:

• Aortic dissection
• Congenital heart disease
• Endocarditis
• High blood pressure
• Radiation therapy to your chest
• Rheumatic heart disease
• Thoracic aortic aneurysm
• Trauma to your chest

Risk factors

You face a higher risk of aortic valve disease if you:

• Are over age 60
• Have signs of calcium buildup on your valve
• Were born with a bicuspid aortic valve
• Have a history of rheumatic fever
• Have certain underlying conditions, like Marfan syndrome, Ehlers-Danlos syndrome and lupus
• Underwent radiation therapy to your chest for cancer, like for Hodgkin lymphoma

Complications of this condition

Aortic valve disease is serious and can lead to complications when untreated. The most common complication is heart failure. This is when your heart can’t pump enough blood to meet your body’s needs. Other complications include:

• Abnormal heartbeats (arrhythmias)
• Infection in your heart (infective endocarditis)
• Heart attack
• Stroke
• Sudden cardiac arrest

How doctors diagnose this condition

Healthcare providers diagnose aortic valve disease by doing a physical exam and running some tests. Your provider will listen to your heart with a stethoscope and do an electrocardiogram (ECG/EKG).

You may also need other tests, including:

• Cardiac CT scan
• Echocardiogram
• Heart cath
• Cardiac MRI
• Stress test — using exercise or medication

Stages

There are four main stages of aortic valve disease. These range from mild to severe and include:

• Stage A (at risk): Your aortic valve is working fine. But you have at least one risk factor for aortic valve disease. You don’t have symptoms.
• Stage B (progressive): This is mild or moderate aortic valve disease. There are some changes to your valve function, but you don’t have symptoms.
• Stage C (asymptomatic severe): This is severe disease. You don’t have symptoms during your normal routine, but may have them during a stress test. Your heart may be able to pump enough blood to your body (stage C1). Or it may have trouble doing so (stage C2).
• Stage D (symptomatic severe): You have severe aortic valve disease that causes symptoms like chest pain or fainting.

The exact criteria for each stage vary slightly based on your condition (stenosis or regurgitation). Your provider uses your test results and symptoms to decide the stage. Without treatment, it can get worse over time.

How is aortic valve disease treated?

Treatment for aortic valve disease involves medicines to reduce your risk of complications and procedures to repair or replace your valve. Your healthcare provider will tailor treatment to your needs. They’ll consider whether your valve is narrowed or leaky (or both), how far the condition has progressed and symptom severity.

Medicines

Medicines can’t fix your valve. But they manage your symptoms and help protect you from complications. Your provider may prescribe medicine to:

• Prevent abnormal heartbeats
• Lower your blood pressure
• Manage your cholesterol levels
• Treat heart failure
• Lower your risk of blood clots

Procedures and surgeries

You may need a procedure or surgery for severe aortic valve disease. Options include:

• Surgical aortic valve replacement (SAVR): Your surgeon replaces your aortic valve with either a tissue valve or a mechanical valve.
• Transcatheter aortic valve replacement (TAVR): This is a minimally invasive procedure that lets you avoid open-heart surgery. Your surgeon fits a new valve inside the old one.
• Aortic valve repair: Your surgeon repairs damage to your aortic valve so you can keep it. This option is less common than replacement.
• Ross procedure: This may be an option if you’re under 60. Your surgeon replaces your aortic valve with your pulmonary valve and gives you a donor pulmonary valve. This lets you avoid having a mechanical valve in the aortic position. But it’s a complicated procedure.

Your provider will explain which procedures or surgeries could help you the most and are safest for you. They’ll also tell you what you can expect in terms of recovery. Be sure to ask any questions so you feel as comfortable as possible moving forward.

When should I see my healthcare provider?

Your provider will tell you how often you need to come in for appointments to manage aortic valve disease. It’s crucial that you go to all of them. You need imaging tests on a regular basis to check your valve and heart function. These tests allow your provider to recommend treatment at the right time.

Call your provider right away if you have:

• New or worsening symptoms
• Side effects from your medicines
• Signs of complications after a procedure or surgery (your provider will tell you what to look out for)

When should I go to the ER?

Call 911 or your local emergency number if you:

• Pass out
• Have difficulty breathing
• Fall while taking blood thinners (these raise the risk of internal bleeding if you hurt yourself)
• Have signs of a wound infection after your surgery or procedure
• Have symptoms of a heart attack
• Have signs of a stroke

What can I expect if I have this condition?

Your outlook depends on many things, including when you’re diagnosed, how far aortic valve disease has progressed and your overall health. Talk to your healthcare provider about your prognosis. They can give you a sense of how you’ll respond to treatment and what to expect.

Here are some ways to help improve your outlook:

• Follow your provider’s advice on the types of exercise that are healthy and safe for you. You may have some exercise restrictions.
• Take good care of your teeth and gums to protect against dangerous heart infections. Having valve disease or an artificial valve raises your risk for these.
• Eat heart-healthy foods.
• Avoid tobacco products.

What is the survival rate of aortic valve disease?

People with aortic valve disease who don’t yet have symptoms have a low risk of sudden cardiac death (less than 1% chance per year). With close monitoring from a healthcare provider, you can live about as long as those who don’t have the condition. It’s crucial that you tell your provider as soon as you notice symptoms developing.

If you have stage D aortic valve disease (symptomatic severe), the prognosis is poor without treatment. Only about half of all people who don’t receive treatment survive at least two years.