What is aortic valve stenosis?
Aortic valve stenosis is a narrowing of the aortic valve. The
aortic valve allows blood to flow from the heart's lower left chamber
(ventricle) into the
aorta. Stenosis prevents the valve from opening
properly, forcing the heart to work harder to pump blood through the valve.
This causes pressure to build up in the left ventricle and thickens the heart
muscle. The heart can compensate for aortic valve stenosis and the resulting
pressure overload for a long time. But eventually the heart will not be able to
maintain the extra effort needed to pump blood through the narrowed valve,
What are the symptoms of aortic valve stenosis?
Aortic valve stenosis generally progresses slowly. For many years, even
decades, you will not feel any symptoms from the heart's effort to overcome
aortic valve stenosis. But at some point, the valve will become so narrow
(usually at least one-quarter of its normal size) that symptoms develop,
- Chest pain (angina) or
discomfort, often described as a heavy, tight feeling in the chest or a
burning, choking, or constricting feeling that may spread to the arms,
shoulders, or neck. Chest pain is often brought on by exertion, when the
workload on the heart increases.
- Dizziness, fainting, or loss of
consciousness, often after periods of activity.
- Signs of heart
failure, such as fatigue and shortness of breath with
- Rapid or irregular heartbeat (arrhythmia).
- Palpitations (an
uncomfortable awareness of the heart beating rapidly or irregularly).
Is surgery the only treatment for aortic valve stenosis?
After you develop symptoms, surgery to replace the aortic valve is the
only effective treatment. Your doctor may prescribe medicines to treat your
symptoms, but after the valve is damaged, it needs to be replaced.
Balloon valvuloplasty, a procedure to enlarge the valve opening, may be
an option for children, teens, or young adults in their 20s who were born with
a bicuspid aortic valve (which has two flaps instead of three). Sometimes this
procedure is used as a temporary fix for people who are older or very ill for
whom open-heart surgery is too great a risk.
For a balloon
valvuloplasty, a thin flexible tube called a catheter is inserted through an
artery in the groin or arm and threaded into the heart. When the tube reaches
the narrowed heart valve, a balloon at the end of the tube is inflated, which
enlarges the valve. In most older adults, the valve becomes narrow again
(restenosis) within 6 to 12 months after this procedure.2 Also, the procedure does not increase survival when it is
done in older adults.
Why is it important to wait for symptoms to develop before having surgery?
Timing is essential-if you have valve surgery too
soon, you will be subjecting yourself to the risk of surgery before it is
necessary, and you will be increasing the chance that you will need another new
valve in the future (because current replacement valves do not last forever).
On the other hand, if you wait too long to replace the valve, your heart may
become permanently damaged, resulting in heart failure.
Is it ever beneficial to have surgery before symptoms develop?
Although the "wait for symptoms" rule applies to the majority of
people, some experts believe that a few people may benefit from valve
replacement surgery before they develop symptoms, particularly those who are at
risk for sudden death.
While sudden death is extremely rare
before symptoms appear, it has occurred. Sudden death is impossible to predict.
But people who experience low blood pressure (hypotension) when they exercise,
have developed serious problems with their left ventricle as a result of aortic
stenosis, or have severe stenosis (a very narrow valve) are at a higher risk of
sudden death. Sudden death in people who have aortic stenosis is closely
associated with heart failure.
If I'm older, should I still have surgery?
people who develop symptoms of aortic valve stenosis are older than 65. Age
alone should not prevent people from having valve replacement surgery.3 Other health problems may increase the risks of surgery,
including coronary artery disease, heart failure, advanced cancer, or a
neurological problem from a previous stroke. If you have other serious health
problems, it is also important to consider whether surgery will improve your
quality of life and chances of survival.
What are the risks of surgery?
The surgery is
relatively low-risk. In people who do not have left ventricular heart failure,
the death rate from surgery ranges from 2% to 5% overall and is as low as 1% in
people who are younger than 70. The death rate is higher (8% to 20%) in people
who have left ventricular heart failure and other markers of poor heart
What new problems could develop after surgery?
Even if valve replacement surgery restores your heart to normal function,
you may have the following problems after surgery:
- An increased risk of blood clots, which can
break off and cause a
heart attack. You will need to take blood-thinning
medicines (anticoagulants) right after surgery to help prevent
blood clots. If you receive a mechanical valve rather than one that is made
from animal or human tissue, you will need to take anticoagulants for as long
as you have that valve.
- A need for another replacement valve.
Current replacement valves do not last forever, meaning that you may need to
replace your valve again in the future.
- Incomplete relief from
symptoms. Some types of valves do not have openings as wide as a normal valve
for a person your size and can limit the valve's effectiveness in relieving
- A malfunctioning valve. There is a small chance
that the valve will malfunction, so you will need to periodically monitor how
well your valve is working.
You will also need to take antibiotics to prevent an
infection of your heart valves when you have certain procedures, such as dental
work or surgery.
Heart surgery, such as valve surgery, also can
cause irregular heartbeat (atrial fibrillation), which can cause
clots to form and increases your risk of heart attack and stroke.
If you need more information, see the topic
Aortic Valve Stenosis.