Aortic Valve Stenosis

You may not experience symptoms of aortic valve stenosis until the disease progresses and becomes severe. The asymptomatic period may last as long as 10 to 20 years. Some people may not experience any symptoms.

Symptoms of severe aortic valve stenosis can include:

• chest pain
• feeling tired after exertion
• shortness of breath or difficulty breathing, especially after exertion
• dizziness, lightheadedness, or fainting
• difficulty sleeping, or only being able to sleep sitting up
• heart palpitations, or abnormal heartbeats
• a heart murmur, which is an abnormal swooshing sound produced by the heart as it beats
• a reduced ability to do your typical activities, including walking short distances
• swollen ankles or feet

Infants and children may have different symptoms from adults, or they may not appear to display any symptoms at all. If they do display symptoms, these may include:

• inability to put on weight
• poor feeding or eating
• becoming easily fatigued
• breathing issues

In severe cases, an infant may have significant breathing difficulties that develop within weeks of birth. Without treatment, mild cases can potentially worsen as the child gets older.

Congenital heart defects, age-related damage, and certain health conditions may prevent the aortic valve from completing its proper functions.

Rheumatic fever

Rheumatic fever is a common cause of heart valve problems in developing countries without effective antibiotic treatment. Rheumatic fever may affect many parts of the body, including the:

• brain
• joints
• heart
• skin

Rheumatic fever can occur in adults and children who have or have had strep throat. Strep throat is a contagious condition caused by Streptococcus bacteria.

Calcification of the valves

Aortic valve stenosis can happen due to calcium buildup (calcification) or scarring of the aortic valve. Aortic valve stenosis may occur in as many as 20% of older adults, according to the American Heart Association. It is most common in people age 65 and older.

While your body needs calcium for strong bones, the mineral may lead to problems in your heart if it deposits in the aortic valve. Calcium deposits usually affect the leaflets of the aortic valve. They can prevent the aortic valve from properly opening and closing.

Improperly functioning aortic valve leaflets may also allow blood to leak back into the left ventricle after it enters the aorta. This is called valvular insufficiency or regurgitation.

It may also be more common in people with certain health conditions, including lupus and end-stage renal disease.

Heart defect

Children may experience aortic valve stenosis due to a heart defect where the aortic valve doesn’t develop properly. When it is, the aortic valve’s flaps, or “leaflets,” irregularly formed. Typically, these leaflets make up the opening of the aortic valve. When functioning properly, they fit together tightly when closed.

Children born with aortic valve stenosis usually have one of the following irregularities in their aortic valve leaflets:

• There are only one or two leaflets.
• The leaflets don’t separate properly.
• The leaflets are too thick or still to completely open or close.

Having an aortic valve with only two leaflets (a bicuspid aortic valve) can lead to increased calcification and then aortic stenosis.

The risk factors for aortic valve stenosis include:

Age

Adults over age 65 may be more likely to develop aortic valve stenosis.

Genetics

Children born with either malformed valve leaflets or fewer than three leaflets typically have problems with sufficient blood flow through the aorta.

Disease

Rheumatic fever can produce significant problems with the valve leaflets. Scar tissue from the disease can make the leaflets hard or even fused together. Rheumatic fever can damage:

• heart tissue
• valves
• coronary arteries

Risk factors for quick progression

Some factors can cause aortic valve stenosis to progress more quickly. These can include:

• a high BMI
• tobacco use
• metabolic syndrome
• high cholesterol
• high blood pressure

After reporting your symptoms to a doctor, you may be referred to a heart specialist (cardiologist). They typically check your physical condition with a thorough examination. This includes listening to your heart for any abnormal sounds. A doctor typically orders an echocardiogram to view the condition of the heart chambers and heart valves.

The doctor may order additional tests to show what’s happening inside your heart. These tests may include:

• cardiac catheterization, which uses dye to assess the pressure and flow of blood through the heart chambers
• other imaging tests, such as a chest X-ray, chest MRI, or CT scan of your heart
• a stress test
• blood test for inflammation of the heart valve (endocarditis) or rheumatic fever

Early treatment may help prevent heart failure. Treatment options may depend on the severity of your condition and may include:

Heart-healthy lifestyle

If you have no symptoms or only mild ones, you may not require treatment. Doctors typically recommend maintaining a heart-healthy lifestyle to prevent disease progression. This can include:

• adopting a heart-healthy diet
• getting regular physical activity
• maintaining a moderate weight
• avoiding smoking, or quit smoking if you smoke
• getting treatment for any severe sore throat to prevent rheumatic fever
• practicing proper dental hygiene, as dental infections can travel through the bloodstream and damage the heart valves and muscles
• managing your blood pressure

Procedures

If your aortic valve stenosis is moderate to severe or you’re experiencing symptoms, a doctor typically recommends a procedure or surgery to repair or replace the damaged valve. Procedures can include:

• Transcatheter aortic valve replacement (TAVR): This minimally invasive procedure replaces your damaged valve with one made from animal tissue.
• Surgical aortic valve replacement (SAVR): This open-heart surgery replaces your damaged valve with a mechanical valve or a valve from a cow, pig, or human donor.
• Valvuloplasty: This minimally invasive procedure repairs your existing valve. Surgeons typically perform it through a soft, thin tube called a catheter, which is less invasive than traditional surgery.

A doctor may recommend a specific procedure depending on your condition and overall health.

Medications

A doctor may prescribe medications to manage symptoms or reduce the burden on your heart. Medications can include:

• Antibiotics: Rheumatic fever requires antibiotics to prevent the infection from advancing and causing heart damage.
• Blood pressure medications: ACE inhibitors can help lower your blood pressure.
• Blood thinners: Blood thinners can help prevent blood blots from forming.
• Antiarrhythmics: Doctors may prescribe antiarrhythmic medications to manage your heart’s rhythm.

Your health may improve dramatically once you receive treatment. Surgical treatments for aortic valve stenosis may allow you to resume an active life. Your outlook depends on a combination of factors:

• how long you’ve lived with the condition
• the extent of damage to your heart
• any complications that may arise from your condition

Without treatment, people with severe aortic valve stenosis typically live for 1 to 3 years from diagnosis.

Doctors diagnose aortic valve stenosis when the aortic valve narrows and doesn’t open properly. People may not show symptoms until stenosis becomes severe. If untreated, aortic stenosis can lead to heart failure.

If you have no symptoms or only mild symptoms, treatment may focus on preventing the disease from worsening.

If your condition is moderate to severe, treatment may involve medical procedures to replace or repair the damaged valve.