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Aortic valve stenosis is a narrowing of the aortic valve. The aortic valve allows blood to flow from the heart's lower left chamber (ventricle) into the aorta and to the body. Stenosis prevents the valve from opening properly, forcing the heart to work harder to pump blood through the valve. This causes pressure to build up in the left ventricle and thickens the heart muscle.
Your heart can make up for aortic valve stenosis and the extra pressure for a long time. But at some point, it won't be able to keep up the extra effort of pumping blood through the narrowed valve. This can lead to
can cause aortic valve stenosis include:
Aortic valve stenosis is a
slow process. For many years, even decades, you will not feel any symptoms. But
at some point, the valve will likely become so narrow (often one-fourth of its
normal size) that you start having problems. Symptoms are often brought on
by exercise, when the heart has to work harder.
As aortic valve
stenosis gets worse, you may have symptoms such as:
If you start to notice any of these symptoms, let your
doctor know right away. If you have symptoms, you need treatment. By the time
you have symptoms, your condition probably is serious. If you have symptoms,
you also have a high risk of sudden death.
people find out they have it when their doctor hears a heart murmur during a
regular physical exam. To be sure of the diagnosis, your doctor may want you to
echocardiogram, which can show moving pictures of your
heart. You may have other tests to help your doctor judge how well your heart
If you don't
have symptoms, your doctor will see you regularly to check your heart. You
probably will not have surgery. Unless you have symptoms, or tests show that the heart's pumping action is getting weak, surgery is likely to
be more risky than the disease.
If you have symptoms, you
probably need surgery right away. Surgery to replace the aortic valve is the
best treatment for most people. View a
slideshow on aortic valve replacement surgery. Some young people or people who cannot
have open-heart surgery may have another procedure called balloon valvuloplasty
to enlarge the valve opening.
If you don't have surgery after you
start having symptoms, you may die suddenly or develop heart failure. Surgery can help you have a more normal life span.
Health Tools help you make wise health decisions or take action to improve your health.
Learning about aortic valve stenosis:
Living with aortic valve stenosis:
Most people who have
aortic valve stenosis are born with a normal, healthy
aortic valve but develop
aortic stenosis late in life. Aging and calcium buildup cause the leaflets of
the valve to thicken and harden, preventing the valve from opening properly.
Typically, stenosis develops slowly over many years.
Most young people and teens who have aortic valve stenosis developed it from a congenital heart defect. The most common heart
defect that causes aortic stenosis is a
bicuspid aortic valve.
Some people may develop aortic stenosis after having rheumatic fever as a child. It usually takes 30 to 40
years after a case of rheumatic fever for aortic stenosis to develop. Rheumatic
fever has been rare in the United States since the 1970s.
You probably won't have any symptoms if
you have mild or moderate
aortic valve stenosis, because your heart can make up
for the stenosis. You may begin to notice symptoms if the pressure buildup in
the heart becomes severe or if blood flow to the heart and the rest of the body
is reduced. You may have symptoms when you exercise or do
something strenuous, because your heart has to work
Symptoms may include:
Certain medical problems or
conditions make it more likely that you will develop
aortic valve stenosis:
Other things that increase the risk for aortic valve
Call your doctor immediately if you have any of the
aortic valve stenosis, such as:
family doctor may diagnose aortic valve stenosis
during a routine checkup. Other health professionals who also may discover
aortic valve stenosis during a physical exam include:
A physical exam and review of your
medical history are important first steps in diagnosing
aortic valve stenosis. If you have stenosis but no
symptoms, your doctor will likely find the condition during a routine exam or a
checkup for another health problem. A distinctive heart murmur is usually the
first clue that leads a doctor to suspect aortic valve stenosis.
During the physical exam, the doctor will:
An echocardiogram (echo) can confirm your symptoms and tell your doctor how severe stenosis is, how well your left ventricle is working, and whether there are problems with other valves.
It's also an important test to help monitor aortic valve stenosis over time.
Every 3 to 5 years
Every 1 to 2 years
Every 6 to 12 months
aortic valve stenosis usually depends on whether you
If you have symptoms, surgery to replace the aortic valve is
usually required. If you don't have your valve replaced after you start having symptoms, you may die suddenly or develop heart failure. Valve replacement can help you have a more normal life span.
slideshow on aortic valve replacement surgery. For more information, see Surgery.
Balloon valvuloplasty is a less invasive procedure that might be done for some children, teens, or young adults in their
20s, or for people for whom valve surgery is too great a risk. For more information, see Surgery.
You may need medicine to prevent or treat a heart infection
or to help manage
heart failure, which is the most common complication of aortic valve stenosis. For more information, see Medications.
People who have symptoms of aortic valve stenosis have a high risk of sudden death. On average, people may die within 2 to 3 years if they don't have valve replacement surgery.1 So it is important
to consider end-of-life issues.
If you choose not to have
surgery, your doctor will prescribe medicines to make you comfortable. As you
get sicker, you may be unable to make decisions about your medical care. You
may want to consider the type of care you wish to receive in case you are
unable to make your wishes known. For more information, see the topic
Care at the End of Life.
How you will feel
aortic valve stenosis will affect your life will vary
greatly depending on whether you have symptoms and the treatment decisions you
For more help, see the topic
Medicines aren't used to treat aortic valve stenosis. But you may need medicines to prevent and treat complications from the condition. Or you may need to take medicines if you have valve replacement surgery.
If you have valve replacement surgery, you may need:
You may need other medicines if you develop other problems, such as arrhythmias or heart failure. For more information, see the topic
Your doctor will likely recommend valve
replacement surgery if you have symptoms of
aortic valve stenosis, unless you have other
health problems that make surgery too risky. Most of the time, valve replacement surgery has a high rate of success and a low risk of causing other problems.
Balloon valvuloplasty is a less invasive procedure than surgery. It may be an option for some younger people who have aortic
valve stenosis. This procedure might be done in older adults who cannot have valve replacement surgery. Although the heart valve is not replaced, the narrowed opening
is made larger.
Aortic valve replacement surgery is either an open-heart surgery or a
minimally invasive surgery. In an aortic valve
replacement surgery, the damaged valve is removed and replaced with an
artificial valve (mechanical or tissue).
slideshow on aortic valve replacement surgery. To learn more about this decision, see:
If you decide to have surgery, you and your doctor will decide which type of valve is right for you. For help with this decision, see:
If you are going to have valve replacement surgery, your doctor may suggest that you have a
coronary angiogram/catheterization test. This test can
show if you have blockages in your
coronary arteries (as part of coronary artery
disease). If you have serious blockages, your doctor may want to do a
coronary artery bypass surgery at the same time as the
valve replacement surgery. For more information, see Aortic Valve Stenosis: Treatment with Other Heart Diseases.
Transcatheter aortic valve replacement is a new way to replace an aortic valve. It does not require open-heart surgery. It is a minimally invasive procedure that uses catheters in blood vessels to replace the aortic valve with a specially designed artificial valve. The catheters are inserted through small cuts in the groin.
This procedure is available in a small number of hospitals. And it is not right for everyone. It might be done for a person who cannot have surgery to replace his or her valve. For example, it might be an option if you are not healthy enough for an open-heart surgery. Although this procedure is minimally invasive, it has serious risks including stroke, kidney problems, and death.2
The Society of Thoracic Surgeons provides patient information on surgeries of the chest and throat that are done by cardiothoracic surgeons. These surgeries include heart, lung, and throat surgery. The patient information section of the website describes diseases, surgeries, patient options, and what to expect after surgery. And using the website, you can search for surgeons in your area.
Visit the American Heart Association (AHA) website for information on
physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your
nearest local or state AHA group. The AHA provides brochures and information
about support groups and community programs, including Mended Hearts, a
nationwide organization whose members visit people with heart problems and
provide information and support.
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
CitationsBonow RO, et al. (2008). 2008 Focused update incorporated into the ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 Guidelines for the management of patients with valvular heart disease). Circulation, 118(15):Holmes DR Jr, et al. (2012). 2012 ACCF/AATS/SCAI/STS Expert consensus document on transcatheter aortic valve replacement. Journal of the American College of Cardiology. Published online January 31, 2012 (doi:10.1016/j.jacc.2012.01.001).Other Works ConsultedBates ER (2011). Treatment options in severe aortic stenosis. Circulation, 124(3): 355–359.Bonow RO, et al. (2008). 2008 Focused update incorporated into the ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 Guidelines for the management of patients with valvular heart disease). Circulation, 118(15):Freeman RV, Otto CM (2011). Aortic valve disease. In V Fuster et al., eds., Hurst’s The Heart, 13th ed., vol. 2, pp. 1692-1720. New York: McGraw-Hill.Leon MB, et al. (2010). Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. New England Journal of Medicine, 363(17): 1597–1607.Oakley RE, et al. (2008). Choice of prosthetic heart valve in today's practice. Circulation, 117(2): 253–256.Rosengart TK, et al. (2008). Percutaneous and minimally invasive valve procedures. A scientific statement... Circulation, 117(13): 1750–1767.
November 2, 2011
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & John A. McPherson, MD, FACC, FSCAI - Cardiology
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