Aortic Valve Stenosis

Symptoms

Valvular aortic stenosis has an extremely wide range of presentation. It can be so severe that emergency intervention is necessary after birth, but for others, the amount of narrowing can be relatively stable without any symptoms for quite some time. Some individuals may have an abnormal-appearing valve, but it may function normally for a long period of time. With severe aortic stenosis, the following symptoms may be present:

• Fatigue
• Shortness of breath
• Fainting (syncope), particularly with exertion or exercise
• Abnormal heart rhythm
• Congestive heart failure
• Sudden cardiac death due to severe ventricular thickening and diminished coronary blood flow

Progression and possible complications

• Left ventricular hypertrophy – With moderate or severe narrowing, the heart’s left ventricle must work harder to pump blood through an opening that’s too small. The extra work leads to the thickening of the wall of the ventricle.
• Heart failure – An overworked left ventricle can fatigue after some time, causing it to fail in its efforts to pump blood to the body, resulting in heart failure. Left ventricular heart failure can lead to high blood pressure in the lungs due to an inability of oxygenated blood to fill the overworked left ventricle easily. Shortness of breath and, eventually, right heart failure may occur. Left ventricular failure will also result in the heart’s inability to provide the body with the amount of blood it needs, leading to symptoms of tiredness or fatigue.
• Critical aortic stenosis – This is the extreme narrowing of the aortic valve in newborns. Before birth, a baby can survive well with only one well-functioning ventricle, but this is not the case after birth. With critical 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 born with this defect will become very ill within hours to days after birth and may not survive without immediate treatment. This usually involves starting a prostaglandin E1 infusion to keep a blood vessel that normally closes after birth (ductus arteriosus) open to allow blood to get to the body. An interventional catheterization procedure called a balloon aortic valvuloplasty may need to be performed shortly after birth. In this procedure, a specifically sized balloon is inflated within the valve to stretch the valve open.
• Progressive valve leakage – Because the aortic valve is abnormally formed, progressive leakage of the valve may occur over time. Balloon valvuloplasty of the aortic valve can make this leakage worse by purposely creating tears between the leaflets. Usually, the amount of leakage of the valve will determine whether one may undergo another balloon valvuloplasty in the future if the aortic valve were to renarrow. Progressive or severe leakage can also require surgery.
• Dilated ascending aorta – Oftentimes, the ascending aorta (area above the aortic valve) may become progressively more dilated over time. While some of this enlargement may be a result of the stress of blood being directed with high velocity toward the wall of the aorta, it’s becoming clearer that some people with aortic valve problems also have an intrinsic abnormality in how the wall of the aorta is formed. As a result, the weaker aortic wall may become enlarged and develop what is called an aneurysm. As the aortic wall becomes progressively more enlarged, there’s an increased risk of tearing of the aortic wall, called a dissection, or even an aortic rupture, which can be a sudden life-threatening event.