• Cardiology And Vascular Health
• Health Topics
• Understanding Heart Disease

Aortic Valve Disease Is Serious But Treatable

A properly functioning aortic valve in your heart plays an important role in your good health. While aortic valve disease (also called aortic stenosis) can be fatal, the disease can be eliminated with a valve replacement procedure.

What’s the Job Of the Aortic Valve?

Your aortic valve is located between the left ventricle of your heart and the aorta. The valve controls the flow of blood as it leaves your heart and enters your aorta and the rest of your body. If you have aortic valve disease, your valve likely is narrowed and isn’t opening properly.

Vincent Nardy, DO, a cardiothoracic surgeon, explains that aortic valve disease develops as the valve narrows. “The narrowing requires the heart to work harder to pump the blood. It strains your heart, and it ultimately can lead to heart failure.”

What Causes the Disease?

Narrowing typically is caused by one of the following:

• Calcium buildup on the valve. The buildup happens slowly over time, which is why you may not have symptoms until you’re 65 or older. “In general, about 2 percent of the population over age 65 have some element of aortic stenosis,” says Dr. Nardy.
• A heart defect that you were born with
• Rheumatic fever or endocarditis. These infections can damage the heart.

What Are the Symptoms?

Symptoms develop gradually, Dr. Nardy explains. They include feeling lightheaded, dizzy, and possibly fainting. Other symptoms may include chest pain or pressure (known as angina), fatigue, shortness of breath, and a feeling that your heart is pounding, racing, or beating unevenly. Once symptoms like these occur, your condition may be serious and could lead to sudden death.

How Is Aortic Stenosis Diagnosed?

Your doctor may suspect aortic stenosis if he detects a rushing sound when he checks your heart with a stethoscope during a physical exam, particularly if you have low blood pressure. Low blood pressure can be a sign of valve disease, and the rushing sound can be characteristic of a restricted aortic valve.

To confirm the diagnosis, your doctor may want you to have an echocardiogram and possibly other tests to see how your heart is working. Other possible tests include ultrasound, electrocardiogram, chest X-ray, cardiac catheterization, exercise stress testing, and magnetic resonance imaging.

Can I Avoid Putting Myself At Risk?

Although aortic stenosis is associated with age, not everyone develops the disease as they get older. Following a heart-healthy lifestyle is ideal:

• Don’t smoke, and avoid secondhand smoke
• Be active and exercise often
• Eat a heart-healthy diet 
• Maintain a healthy weight

How Is Aortic Stenosis Treated?

If your disease is mild to moderate and you don’t have symptoms, treatment may involve medications to keep your blood pressure and cholesterol under control. “We’ll also ask you to quit smoking and appropriately manage your blood sugars and diabetes,” Dr. Nardy says.

“If your disease progresses beyond moderate and you get to a severe stage, or an even higher stage that we call critical, that’s when we start discussing possible valve replacement,” Dr. Nardy explains. “At this point, if you develop severe aortic stenosis with symptoms and do absolutely nothing to treat it, you likely will die within two to five years. The natural progression of this disease is that it gets worse.”

Valve replacement may be accomplished through traditional open-heart surgery, requiring a large incision in your chest or a minimally invasive small incision in the right chest. “We call both of these approaches surgical aortic valve replacement, or SAVR,” says Dr. Nardy.

While traditional, open-heart aortic valve replacements are very successful, some patients are not good candidates.

These patients, though deemed high-risk for open-heart surgery, may be considered appropriate for minimally invasive transcatheter aortic valve replacement (TAVR). This procedure involves going through the groin to replace your valve.

“We use X-ray and small needles and wires to insert a new valve without cutting open the chest,” Dr. Nardy explains. TAVR is commonly used in patients who are severe or high risk. It also is being studied for patients with moderate disease or lower risk. “But we don’t have all the answers just yet for this lower risk category of patients,” he adds. In these instances, a team of surgeons will collaborate on a patient-by-patient basis to determine the best treatment option for you.

Patients who benefit from TAVR are those who are at high risk for surgical complications, including:

• Elderly patients
• Patients with kidney disease and/or insufficient kidney function
• Patients who have had prior open chest procedures (sternotomies)
• Patients who have had prior heart surgeries
• Patients who have had prior lung surgeries

Source: Vincent Nardy DO, Cardiothoracic Surgery Associates; American Heart Association