What Is the Aortic Valve?

Your aortic valve is an essential barrier between your heart and your body. When it works properly, the aortic valve is a one-way valve that separates the left ventricle, the main pumping chamber of your heart, from your aorta, the main artery that carries oxygenated blood to your entire body.

With each heartbeat the left ventricle fills with blood and as the pressure inside the ventricle builds, the valve opens to allow the blood to pass into the aorta, where it will be carried throughout your body.

Types of Heart Valve Disease

There are two primary diseases that can occur with the aortic valve:

  1. Aortic stenosis
  2. Aortic aortic insufficiency

It’s important to understand and recognize the causes, symptoms, and treatments for these two types of aortic valve disease.

Aortic Stenosis

Aortic stenosis happens when your aortic valve does not open all the way causing pressure to build in the left ventricle. This pressure blocks blood flow as it leaves the heart. In other words, the aortic valve narrows and cannot open all the way.

Since the aortic valve regulates the blood flow between the aorta and the left ventricle, this restricted blood flow causes symptoms like shortness of breath, fatigue, and passing out. The increased stress on the heart can cause damage that leads to heart failure.

Causes of Aortic Stenosis

The three most common causes of aortic stenosis are:

  1. Congenital heart defects,
  2. Calcification of the heart valve, and
  3. Rheumatic fever.

How the Aortic Valve Works

To understand these causes, it helps to understand how the aortic valve works. Inside your heart there are four valves that all work to make sure blood flows from your body into the correct chambers, in the correct order, and back out into your body. These four little valves have tiny flaps called cusps that open and close every time your heart beats.

When the aortic valve won’t open all the way because it has narrowed or the cusps have calcified, your heart has to work harder to pump enough blood out of the left ventricle and into your aorta. This reduced blood flow can cause symptoms, including shortness of breath, fatigue, and passing out.

Over time, this extra work can make the left ventricle of the heart get bigger or thicker.  Eventually this can cause heart failure or other heart problems.

Congenital Defects

The most common congenital heart condition occurs when someone is born with only two cusps on their aortic valve instead of the usual three (bicuspid aortic valve). This is the most common congenital cardiovascular problem. Approximately one to two percent of the population is born with a bicuspid aortic valve. It is also possible for someone to have just a single cusp on the aortic valve, or to have four, but those defects are rare. 

Many people don’t know that they have this congenital heart defect until they are adults when the heart valve begins leaking or causing symptoms. We don’t have a lot of information about how heart valves develops abnormally, so it’s not a condition that you would be able to prevent 

This can be an inherited condition, so it is important to talk to your cardiovascular specialist about your family members to discuss if screening is needed.

Calcification of the Valve

Calcium is a mineral that flows through your blood. Over time as blood pumps in and out of your heart small deposits of calcium can start to build up on the flaps on the valves in the heart. For some people, these small calcium deposits will not cause any issues, but for others these tiny calcium deposits can cause the cusps to harden or stiffen. This makes it difficult for them to open all the way. 

Consuming calcium by drinking calcium-rich drinks or taking calcium supplements does not increase the risk of aortic stenosis. Since calcification happens over time, it is most common in older adults over the age of 70.

Rheumatic Fever

Sometimes a strep throat infection can lead to rheumatic fever. This causes scar tissue to build in the aortic valve. This excess tissue may narrow the valve, making it difficult for the valve to open and close all the way. Since scar tissue is often a rough surface, it can also create the perfect place for calcium deposits to collect.

Today rheumatic fever is rare in the United States, but an older adult that had the fever as a child may be at higher risk of developing aortic stenosis.

Other Risk Factors for Aortic Stenosis

Additional things that could put you at higher risk for developing aortic stenosis include:

  • Old age,
  • History of infections that impacted your heart,
  • High blood pressure,
  • Diabetes,
  • High cholesterol,
  • Chronic kidney disease, and
  • Radiation therapy in the area near your heart.

Symptoms of Aortic Stenosis

In some patients the aortic valve may narrow slightly but they will never have any noticeable symptoms. However, when you develop symptoms, it usually means that the valve narrowing is severe. 

For many patients, the symptoms of aortic stenosis occur during or after physical activity, although they may also occur any time. These can include: 

  • Tightness in the chest or chest pain;
  • Dizziness, lightheadedness, or fainting during or after physical activity;
  • Shortness of breath during or after physical activity;
  • Fatigue during times of increased activity;
  • Heart palpitations or heart murmurs; and/or
  • Abnormal heartbeat.

Over time if you don’t get treatment, aortic stenosis can lead to heart failure. Symptoms of more severe heart failure include:

  • Swollen ankles and feet,
  • Shortness of breath, and
  • Severe fatigue.

Aortic valve stenosis can also increase your risk of stroke, blood clots, infections, and bleeding. A cardiovascular specialist should monitor and treat the symptoms to avoid damage to your heart or even death.

If you are experiencing symptoms of aortic stenosis, it’s important to schedule an appointment with a cardiovascular specialist immediately.

Treatment for Aortic Valve Stenosis

Treatment for aortic stenosis can include:

  • Preventive lifestyle adjustments, such as reducing strenuous activities or limiting physical activity for patients with mild aortic stenosis.
  • Aortic valve repair or valve replacement, which may involve open heart surgery or transcatheter aortic valve replacement.

Transcatheter Aortic Valve Replacement (TAVR)

Another option for some patients is transcatheter aortic valve replacement (TAVR).  This is less invasive than the traditional open-heart surgery to replace the aortic valve, but we don’t recommend it for every patient.

Depending on how severe your aortic stenosis is will help you and your doctors decide on a treatment plan.

Diagnosis of Aortic Stenosis

The multidisciplinary heart valve team at the University of Utah Health will generally diagnose the condition with physical examination and echocardiography. Once you are diagnosed, your cardiologist may recommend catheterization to monitor the pressure inside your heart and look for any other signs of coronary artery disease.

There are currently no medications that treat aortic stenosis, but your physician may recommend that you take other medications to reduce the risk of complications from diseases like high blood pressure or high cholesterol. 

Studies have shown that undergoing a valve replacement procedure for aortic stenosis is an effective treatment method, and that following surgery, patients over the age of 65 have only a slightly lower life expectancy than someone who have the condition at all. The surgery was also shown to reduce the risk of stroke.

Next Steps After Being Diagnosed With Aortic Stenosis

If you are diagnosed with aortic stenosis, your physician will recommend a specific treatment plan based on how severe your condition is. This could be one of the following:

Mild: For patients with mild aortic stenosis or those with no symptoms, a cardiologist may recommend regular screenings and follow-up every three to six months.

In some cases your cardiologist may recommend surgery even if you’ve never experienced any symptoms, particularly if diagnostic tests reveal that you are at an elevated risk of developing heart disease or other complications.

Moderate to Severe: Patients with moderate to severe aortic stenosis may need surgery to repair or replace the aortic valve.

Aortic Insufficiency (Aortic Regurgitation)

Aortic insufficiency occurs when your aortic valve fails to close properly once the blood enters the aorta. This causes blood to flow the wrong way back into the heart.

When the left ventricle doesn’t fully empty and some blood remains, it forces the ventricle to hold more blood than normal as the next heartbeat pulls in more oxygenated blood from the left atrium. The heart has to do extra work to hold this additional blood. This can lead to enlargement of the left ventricle, weakening the heart and leading to heart failure.

Causes of Aortic Insufficiency

The most common causes for aortic insufficiency are:

  • deterioration of the heart valve over time,
  • dilation of the aorta (aortic root aneurysm),
  • infections,
  • high blood pressure,
  • trauma, or
  • congenital heart defects.

In patients with a congenital defect, you may not know about the condition until later in life when you experience symptoms.

For patients without a congenital cause for the disease, aortic insufficiency often gets worse with age as your heart valves wear out over time.

Risk Factors for Aortic Insufficiency

Similar to aortic stenosis, the most common risk factors for developing aortic insufficiency include:

  • Old age,
  • Frequent infections,
  • Rheumatic fever,
  • Prolonged high blood pressure,
  • Chronic kidney disease, and
  • Radiation therapy in the chest area.

Symptoms of Aortic Insufficiency

Some of the most common symptoms you may experience with aortic insufficiency include: 

  • Shortness of breath with high levels of exertion or while lying on your back;
  • Feeling fatigued or weak during period of increased activity;
  • Heart palpitation, irregular heartbeats, or heart murmurs;
  • Swelling in the ankles and feet; and/or
  • Chest pain or tightness, particularly during or after physical activity.

If you experience these symptoms, you should schedule an appointment with a cardiologist immediately. 

He or she will use echocardiography to identify and diagnose aortic insufficiency. Your doctor can then recommend the appropriate treatment plan based on how severe your condition is.

Some patients experience symptoms of the disease suddenly (called acute aortic regurgitation), while others experience an extended deterioration that eventually leads to aortic regurgitation (chronic valvular insufficiency).

Acute Aortic Regurgitation

Trauma can cause acute insufficiency by damaging the aortic valve. An infection, such as endocarditis, can also damage the heart causing acute aortic regurgitation or complications following a valve replacement.

Chronic Aortic Regurgitation

Chronic aortic regurgitation occurs slowly over time as the aortic valve wears out and eventually cannot close entirely. Patients that experience chronic regurgitation often won’t experience any symptoms for many years and may not get a diagnosis until much later in life when you do begin to experience symptoms.

Treatment Options for Aortic Insufficiency

For patients with mild aortic regurgitation, we may recommend reducing the level of physical exertion and exercise or limiting specific exercises that could increase the risk of complications. Instead we may recommend focusing on safe exercises that allow you to remain active and not increase your risk of complications.

For moderate to severe aortic insufficiency, we will usually perform open heart surgery to either repair the damaged aortic valve or replace it entirely. Surgical repair is an option in situations where the damage is minimal or easy to correct, or for patients that are younger and in good overall health.

For patients that cannot have the valve repaired, replacement of the valve with a prosthetic is an option, and some patients may be good candidates for the less invasive transcatheter aortic valve replacement (TAVR) surgery.

Preventing Aortic Valve Disease

If you develop aortic valve disease because of a congenital heart defect, you cannot prevent the disease. However if you don’t have a congenital heart defect, there are some steps you can take to reduce the risk of developing aortic valve disease.  

Take antibiotics when you have strep throat to prevent rheumatic fever. Strep throat can be easily tested at your doctor’s office and antibiotics can usually treat this disease quickly and effectively. This will help you avoid complications that can lead to rheumatic fever and heart damage.

Reduce your risk of heart disease by:

  • keeping your blood pressure under control,
  • managing diabetes appropriately,
  • maintaining healthy cholesterol levels (and having your cholesterol checked regularly), and
  • maintaining a healthy body weight to avoid obesity.

Take care of your teeth and gums. There is increasing evidence that having healthy teeth and gums and avoiding gingivitis can reduce the risk of endocarditis, which is an infection in heart tissue that could damage the aortic valve.

Brushing and flossing daily and seeing your dentist every six months for a cleaning and checkup can reduce your risk of developing gum disease.

Schedule a Consultation

Need to see a heart valve specialist? First thing to do is get a referral from your primary care doctor. Once you have referral and have made an appointment, you can prepare for your appointment by:

  • Letting your insurance know you have an appointment and reviewing your insurance coverage.
  • Having a copy of your medical history ready.

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