The aortic valve is on the left side of your heart at the top of the left ventricle. It opens to allow blood pumped from the left ventricle (main pumping chamber) out into the aorta (main blood vessel) and then circulate to the rest of your body. Aortic stenosis refers to a narrowing of this valve so that is not fully open and blood flow to the body is restricted.
The aortic valve has leaflets that open and close with each heartbeat and allow the blood to be pushed out to the body. In aortic stenosis, these leaflets become stiff and no longer open and close properly, narrowing the opening of the valve and restricting blood flow.
Aortic stenosis may be present at birth (congenital) or it may develop later in life (acquired). It is the most common valve disorder seen in the U.S. and Europe. Its incidence increases with age and it affects more than 2.5 million people over the age of 75 in the United States.
Symptoms and Signs
Common symptoms of aortic stenosis include:
- Shortness of breath
- Chest pain
- Fainting (syncope) or dizziness
- A heart murmur
- Decreased ability to exercise
- Health palpitations
Sometimes patients with severe aortic stenosis can have no symptoms and the only indication may be a heart murmur that can be heard through a stethoscope.
Progression and Possible Complications
Aortic stenosis may be mild, moderate, or severe, which refers to the valve’s ability to function properly. Patients with aortic stenosis can be symptomatic or asymptomatic, but the severity of symptoms does not always correlate perfectly with the severity of the valve functioning. For instance, it’s possible to have no symptoms but still have severe aortic stenosis.
However, aortic stenosis is a progressive disease. Once symptoms appear, the disease tends to worsen over time, sometimes fairly quickly. It is important to not delay treatment as untreated, symptomatic severe aortic stenosis is associated with a poor prognosis.
With moderate or severe narrowing of the aortic valve, the heart needs to work harder to pump blood to the body. This extra workload can eventually lead to heart failure, a condition in which the heart stops being able to effectively pump blood to meet the body’s needs.
Critical neonatal aortic stenosis is the extreme narrowing of the aortic valve in newborns. Before birth, a baby can survive well with only one well-functioning ventricle. That is not the case after birth. With critical neonatal aortic stenosis, the left ventricle is not able to pump blood adequately through the narrowed aortic valve and into the body. As a result, a child with this defect will become very ill soon after birth. Unless the condition is treated immediately, it could lead to death.
There are essentially three treatment options for aortic stenosis: surgical valve replacement, transcatheter aortic valve replacement (TAVR), or medical therapy. The best treatment for you depends on how severe your condition is and what other medical conditions you might have.
No treatment is generally recommended for patients who are asymptomatic and have mild aortic stenosis. However, aortic stenosis is a progressive disease, meaning it worsens over time, so ongoing monitoring of the condition is important to determine the presence of signs and symptoms or a worsening in heart function.
There is no established medical therapy for aortic stenosis in that there are no drugs that will “cure” the valve narrowing. Medical treatment is directed toward preventing complications and reducing the symptoms of the disease.
Open-heart surgical aortic valve replacement was previously considered the treatment of choice for most patients with symptomatic aortic stenosis, as long as they weren’t too sick to undergo the procedure.
TAVR (or TAVI, with the “I” standing for Implantation) is a minimally invasive procedure used to replace the aortic valve. Unlike the surgical option, TAVR is performed on a beating heart and does not require cardiopulmonary bypass, making it a less risky option than surgical aortic valve replacement, especially in older and sicker patients. Based on recent studies that directly compared TAVR to surgical aortic valve replacement, TAVR currently is considered an equal or better option for many patients who are considered at high or intermediate risk for complications from surgical valve replacement. (Click here for more information on TAVR).