Aortic valve stenosis (AS) is a heart condition that happens when the aortic valve is narrower than is normal. In moderate or severe forms, this can create significant problems, as the left ventricle works harder to pump blood, which then travels through the rest of the body, in through the aorta. There are numerous causes of AS and a couple of preferred treatments, though in mild cases, no treatment may be necessary. The condition does need to be taken seriously and may worsen over time, causing congestive heart failure.
The aortic valve is the passageway between the left ventricle and the aorta, and the normal valve has three leaflets that open and tightly close with each heart contraction. If aortic valve stenosis is present the function of the leaflets may be compromised, or in some cases only two exist, which is called bicuspid. This narrowing means the left ventricle works harder and the extra work can increase the size of the ventricle.
Unlike other muscles, increased size doesn’t make the heart stronger; it weakens it. The heart will pump with less force, which can compromise blood flow to the rest of the body and create problems like accumulated blood or fluid in the lungs or the body. In most cases, compromise of one area of the heart results in poor function in almost all areas.
The typical causes of aortic valve stenosis include congenital heart disease, bicuspid aortic valve, certain illnesses, or calcium build-up, usually related to aging. Some babies are born with severe AS and require immediate intervention, and other people have two versus three leaflets, which may progress to AS at a later point. Rheumatic fever was a common cause of this condition, though it is now rarer. People with no aortic valve problems in the past may also develop aortic valve stenosis if calcium or plaque builds up and narrows the valve.
Common symptoms of aortic valve stenosis may vary based on severity of the disease. Some people have tight feelings in their chest, they may have trouble breathing, be more fatigued, and people might note differences in the way the heart beats. Very mild cases of stenosis may be asymptomatic, and more severe cases could have symptoms like fluid retention and severe arrhythmias. Given these symptoms, cardiologists perform examinations like electrocardiograms (EKG), echocardiograms, and chest x-rays, to look for AS.
If AS is found, the next determination is treatment. Mild aortic valve stenosis may simply be followed to see if it is worsening. If the condition is more significant, doctors could consider using balloon angiography in a cath lab setting to expand the narrowed valve.
The other option is surgical, where the narrowed valve is replaced with either a mechanical or tissue valve. Though heart surgery is frightening to contemplate, the surgery is relatively common and is successfully performed on anyone from newborns to the elderly in many hospitals. People who have this surgery can expect many of the symptoms of stenosis to reverse as a result, though further valve replacement surgeries are sometimes necessary, particularly in growing children.
