Aortic valve disease is a condition that occurs when the main artery of your body, the aorta, and the left ventricle of the heart malfunction. The aortic valve determines how blood flows from the left ventricle (the lower left chamber of the heart) to the aorta.
There are two different types of aortic valve disease—aortic stenosis and aortic regurgitation. In the case of aortic stenosis, the opening of the aortic valve is narrower than it should be. In aortic regurgitation, some of the blood leaks back into the left ventricle because the aortic valve does not close tightly enough.
One cause of aortic stenosis is a congenital heart defect present at birth. The valve of the aorta is made up of three triangular flaps called leaflets. When working properly, the leaflets fit tightly together allowing the blood to flow in only one direction. With a congenital defect, your aortic valve may only have one (unicuspid) or two (bicuspid) leaflets instead of the usual three. This type of aortic stenosis may not show any symptoms until adulthood, when the valve finally begins show signs of leaking or narrowing.
A buildup of calcium on the aortic valve’s leaflets can also cause aortic stenosis. As blood flows through your heart, calcium gradually accumulates on the leaflets. The calcium deposit can cause the leaflets to stiffen and narrow the aortic valve. But this form of aortic valve disease usually only appears in older patients.
Rheumatic fever and scarlet fever can also cause aortic stenosis. Rheumatic fever (and scarlet fever) can begin as strep throat and then leaves scars on the aortic valve. The scars can cause the aortic valve to narrow. This scar tissue may also give calcium a surface on which to collect.
Aortic regurgitation shares some of the same causes as aortic stenosis but is sometimes caused by simple wear and tear. With the aortic valve opening and closing thousands of times per day, as time goes on, normal wear may cause the valve to malfunction. The worn valve may allow blood to flow back into the left ventricle.
Endocarditis is an infection of the valves of the heart that also can cause aortic regurgitation. Although rare, syphilis, a sexually transmitted disease, can damage the heart valve. Even more rare, heart valve damage is a side effect of a disorder of the spine called ankylosing spondylitis. Both types of damage also can cause aortic regurgitation.
While both forms of aortic valve disease share similar symptoms, like chest pain during exercise that eases when at rest, they do have a few different symptoms. Aortic stenosis may cause:
- swollen ankles
- shortness of breath
- rapid or fluttering pulse
Aortic regurgitation can cause:
- fainting, usually during physical activity
- heart palpitations
Both aspects of aortic valve disease may take a number of years to appear. Consequently, if you experience these symptoms and have—or have had—any of the conditions that would put you at risk (rheumatic fever, scarlet fever, etc.), you should tell your physician about your symptoms.
Both diseases are diagnosed in similar ways. Your doctor will likely ask you questions about your health history, as well as the health history of your family. You doctor may order an echocardiogram, a test that uses sound waves to create an image of the heart and aortic valve. A chest X-ray is also commonly used to diagnose aortic valve disease.
If these tests do not provide a definitive diagnosis, your doctor may suggest a cardiac catheterization. This procedure uses a dye to highlight any leaks your heart valves. The dye is injected through a vein in your groin or arm and then tracked on a monitor as it moves through your heart.
There are currently no medications available to treat the valve problems of aortic stenosis or aortic regurgitation, but your doctor can prescribe medications that can lessen the effects of the disease.
In the case of aortic regurgitation, medication can lower your blood pressure and prevent the buildup of fluid. If you have aortic stenosis, your doctor may recommend the use of drugs that control the disturbances of the heart’s rhythm. Beta and calcium blockers can help with any angina (chest pain). Your doctor may prescribe statin drugs to lower your blood cholesterol levels.
While there are several surgical methods of treatment for aortic valve disease, the most common and most effective is aortic valve replacement. In this procedure, a surgeon will remove your damaged aortic valve and replacing it with a new one made from a human donor or a large animal, such as a cow or pig.
Your surgeon may opt for a mechanical valve. These are made of metal and sturdy, but they increase your risk for blood clots in the heart. If you have a mechanical valve, you may need an anticoagulant drug such as warfarin (Coumadin) for permanent management of your condition.
Rather than replace the valve, your surgeon may choose to repair the valve with a procedure called a valvuloplasty. This method does not require long-term, post-op (after the operation) medication as with valve replacement. In such surgery with infants and children, a balloon valvuloplasty may be performed. The procedure inserts a thin tube with a balloon at the tip into the body. The surgeon guides the balloon to the aortic valve and inflates it. The inflated balloon opens and stretches the opening of the valve and improves blood flow. This type of valvuloplasty is usually not performed on adults due to the likelihood that the valve would narrow again later on.
Take steps to lower your chances of developing aortic valve disease. Here are a few suggestions:
- Prevent rheumatic and scarlet fever. If you have a sore throat you may want to have it checked by your doctor to make sure that it’s not strep that could progress into something that could damage your heart.
- Practice good dental hygiene. Making sure that your teeth and gums are well cared for reduces the chance of bloodstream infections that cause endocarditis.
- Make sure your heart is healthy. If you have high blood pressure or high cholesterol, talk to your doctor about steps you can take to lower them. Both of these conditions have close links to aortic valve disease.