Overview of aortic valve disease

Aortic Valve Disease entails damage to, and dysfunction of, the aortic valve, one of the four valves in the heart. The most common valvular problem in old age is aortic valve disease. The aortic valve is one of four valves that control the flow of blood into and out of the heart. In particular, the aortic valve controls the flow of oxygenated blood pumped out of the heart from the left ventricle into the aorta, the main artery leading to the rest of the body.

Aortic valve disease symptoms vary and can be confused with the regular process of aging

Some patients have minimal symptoms, but valve disease is progressive and will eventually lead to heart failure if left alone.

Aortic valve disease symptoms include:

  • Shortness of breath
  • Chest pain
  • Irregular heartbeat
  • Fatigue
  • Swollen ankles/feet
  • Difficulty lying flat, needing multiple pillows or needing to sit up
An X-ray showing an aortic valve with a red arrow indicating the diseased part of the valve

Aortic valve conditions

The aortic valve is located between the left ventricle and the aorta. As the left ventricle contracts, it pumps blood out of the left ventricle through the aortic valve and into the aorta. The aortic valve consists of three leaflets, or flaps, that open to allow blood to flow from the ventricle to the aorta and close to prevent blood flow in the opposite direction.

Aortic Valve Stenosis
Aortic valve stenosis is a heart condition that occurs when there is an inadequate opening of the aortic valve that limits blood flow to the body. Degeneration and calcification of the valve with age can cause stenosis, but there are several other causes of aortic valve stenosis, including rheumatic fever, a congenital bicuspid aortic valve and radiation therapy.

Aortic Valve Regurgitation
Aortic valve regurgitation occurs when the aortic valve leaflets do not close properly and blood returns back to the heart. This kind of heart problem may be caused by an enlargement of the aortic root in aneurysms, by endocarditis or infection, rheumatic fever or injury.

A medical illustration of an aortic valve showing the annulus and three cusps

Diagnosing aortic valve disease

The severity of the disease and symptoms helps determine aortic valve treatment

Evaluating aortic valve disease includes:

  • EKG
  • Echocardiogram (ultrasound of the heart)
  • Cardiac catheterization
  • CT scan with contrast. The CT scan provides information for patients considering a catheter procedure, like transcatheter aortic valve replacement (TAVR), who previously had heart surgery. It helps determine the suitability of the anatomy for the TAVR procedure and whether alternate access other than the femoral arteries would be required. Occasionally the CT scan is used to determine the severity of the stenosis by quantifying the calcium buildup on the valve.

Decisions on the right aortic valve treatment are based on discussions with our heart team, including a cardiologist, cardiac surgeon and the primary care physician. Patients with advanced heart failure may not be candidates for surgery and can consider treatment options directed at heart failure.

Aortic valve replacement

Aortic valve disease treatment involves an aortic valve replacement.

What to expect during aortic valve surgery

Preoperative

After an evaluation by the heart team and undergoing appropriate testing, you will meet our nurse educator who will give you a booklet and talk to you about the stepwise progression you will be expected to make through your heart surgery for aortic valve disease. Your medications will be discussed, and you may be asked to stop certain medications up to one week before the aortic valve surgery procedure. It is important to plan ahead and make arrangements for transportation to and from the hospital and also help at home after the procedure.