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Aortic valve disease

Overview

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:

Aortic valve stenosis

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.

Aortic valve regurgitation

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.

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 aorta. Mild cases may not have symptoms initially, but they can worsen over time. Typically the aortic valve has three cusps (tricuspid aortic valve), but some people are born with an aortic valve that has two cusps (bicuspid aortic valve).

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 aorta. Mild cases may not have symptoms initially, but they can worsen over time. Typically the aortic valve has three cusps (tricuspid aortic valve), but some people are born with an aortic valve that has two cusps (bicuspid aortic valve).

Aortic valve regurgitation

In aortic valve regurgitation, the aortic valve doesn't close properly, causing blood to leak backward from the aorta into the left ventricle.

Symptoms

Some people with aortic valve disease may not experience symptoms for many years. Signs and symptoms of aortic valve disease may include:

  • Abnormal heart sound (heart murmur) heard through a stethoscope
  • Shortness of breath, particularly when you have been very active or when you lie down
  • Dizziness
  • Fainting
  • Chest pain or tightness
  • Irregular heartbeat
  • Fatigue after being active or having less ability to be active
  • Not eating enough (mainly in children with aortic valve stenosis)
  • Not gaining enough weight (mainly in children with aortic valve stenosis)
  • Swelling of the ankles and feet

When to see a doctor

If you have a heart murmur, your doctor may recommend that you visit a cardiologist. If you develop any symptoms that may suggest aortic valve disease, 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, 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.

Chambers and valves of the heart

A normal heart has two upper and two lower chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of your heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings.

Chambers and valves of the heart

A normal heart has two upper and two lower chambers. The upper chambers, the right and left atria, receive incoming blood. The lower chambers, the more muscular right and left ventricles, pump blood out of your heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings.

Aortic valve stenosis

In aortic valve stenosis, there is progressive narrowing of the aortic valve opening over time (top row), which results in increased pressure within the heart and reduced capacity 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 progressive pressure buildup within the garden hose.

Risk factors

Risk factors of aortic valve disease include:

  • Older age
  • Certain heart conditions present at birth (congenital heart disease)
  • History of infections that can affect the heart
  • Chronic kidney disease
  • History of radiation therapy to the chest

Complications

Aortic valve disease can cause complications, including:

  • Heart failure
  • Stroke
  • Blood clots
  • Heart rhythm abnormalities
  • Death

Diagnosis

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 3-D 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).

  • Electrocardiogram (ECG). In this test, wires (electrodes) attached to pads on your skin measure the electrical activity of your heart. An ECG can detect enlarged chambers of your heart, heart disease and abnormal heart rhythms.
  • Chest X-ray. A chest X-ray can help your doctor determine whether the heart is enlarged, which can indicate certain types of aortic valve disease. It can also show whether you have an enlarged blood vessel (aorta) leading from the heart or any calcium buildup on the aortic valve. A chest X-ray can also help doctors determine the condition of your lungs.
  • Cardiac computerized tomography (CT) scan. A cardiac CT scan uses a series of X-rays to create detailed images of your heart and heart valves. Doctors may use this imaging technique to measure the size of your aorta and look at your aortic valve more closely.
  • Cardiac MRI. A cardiac MRI uses magnetic fields and radio waves to create detailed images of your heart. This test may be used to determine the severity of your condition and evaluate the size of the aorta.
  • Exercise tests or stress tests. Exercise tests help doctors see whether you have signs and symptoms of aortic valve disease during physical activity, and these tests can help determine the severity of your condition. If you are unable to exercise, medications that have similar effects as exercise on your heart may be used.
  • 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.

Treatment

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 symptoms are mild 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 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:

Aortic valve repair

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 repair 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 arm or 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 leaking replacement aortic valve.

Aortic valve replacement

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 intermediate or high 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.

Biological valve replacement

In a biological valve replacement, a biological or tissue valve replaces the damaged valve.

Biological valve replacement

In a biological valve replacement, a biological or tissue valve replaces the damaged valve.

Mechanical valve replacement

In a mechanical valve replacement, a mechanical valve replaces the damaged valve.

Transcatheter aortic valve replacement (TAVR)

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace a narrowed aortic valve that fails to open properly (aortic valve stenosis). In this procedure, doctors insert a catheter in your leg or chest and guide it to your heart. A replacement valve is inserted through the catheter and guided to your heart. A balloon is expanded to press the valve into place. Some TAVR valves are self-expanding.

Preparing for an appointment

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.

What you can do

  • Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do beforehand.
  • Write down your symptoms, including any that seem unrelated to heart valve disease.
  • Write down key personal information, including a family history of heart disease, and any major stresses or recent life changes.
  • Make a list of all medications, vitamins and supplements you take.
  • Take a family member or friend along, if possible. Someone who accompanies you can help you remember information you receive.
  • Be prepared to discuss your diet and exercise habits. If you don't already eat well and exercise, be ready to talk to your doctor about challenges you might face in getting started.
  • Write down a list of questions to ask your doctor.

For aortic valve disease, some basic questions to ask your doctor include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes for my symptoms or condition?
  • What tests will I need?
  • What's the best treatment?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Should I see a specialist?
  • If I need surgery, which surgeon do you recommend for heart valve surgery?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there brochures or other printed material I can take with me? What websites do you recommend?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Questions your doctor is likely to ask include:

  • When did your symptoms begin?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

Lifestyle and home remedies

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:

  • Eating a heart-healthy diet. Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish, and whole grains. Avoid saturated and trans fat, and excess salt and sugar.
  • Maintaining a healthy weight. Aim to keep a healthy weight. If you're overweight or obese, your doctor may recommend that you lose weight.
  • Getting regular physical activity. Aim to include about 30 minutes of physical activity, such as brisk walks, into your daily fitness routine.
  • Managing stress. Find ways to help manage your stress, such as through relaxation activities, meditation, physical activity, and spending time with family and friends.
  • Avoiding tobacco. If you smoke, quit. Ask your doctor about resources to help you quit smoking. Joining a support group may be helpful.

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.

Coping and support

If you have aortic valve disease, here are some steps that may help you cope:

  • Take medications as prescribed. Take your medications as directed by your doctor.
  • Get support. Having support from your family and friends can help you cope with your condition. Ask your doctor about support groups that may be helpful.
  • Stay active. Aim to stay physically active. Your doctor may give you recommendations about how much and what type of exercise is appropriate for you.

Last updated: August 12th, 2017

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