Aortic Stenosis

Authored by , Reviewed by Dr Adrian Bonsall | Last edited | Certified by The Information Standard

The aortic valve is a heart valve that lies between the left ventricle and the aorta. Aortic stenosis means that when the aortic valve opens, it does not open fully. The opening between the left ventricle and the aorta is therefore narrowed (stenosed).

As a result, the amount of blood that can pass from the left ventricle to the aorta is reduced. The more narrowed the valve, the less blood can get through and the more severe the problem is likely to be.

In some cases, aortic stenosis occurs at the same time as aortic regurgitation.

Mild aortic stenos may not cause any symptoms. However the symptoms associated with more severe aortic stenosis may include:

If the narrowing (stenosis) is mild then you may not need any treatment. If you develop complications, various medicines may be advised. However, surgery is advised in most cases when symptoms develop. This is because studies have shown that once symptoms develop, the average survival is two to three years if the valve remains narrowed. With surgery, the outlook is very good.

Medication

Medication may be advised to help ease symptoms of heart failure if heart failure develops - for example, angiotensin-converting enzyme (ACE) inhibitors and/or 'water' tablets (diuretics). See separate leaflet called Heart Failure for more details on treatment methods.

Surgical treatments

An operation to fix aortic stenosis is a commonly done procedure. It has a very good chance of success. If you need surgery, a surgeon will advise on which is the best option for your situation. The possible options include the following:

An operation to widen the valve (valvotomy)
This requires open heart surgery.

Open heart surgery to replace the valve 
The replacement may be with a mechanical or a tissue valve.

  • Mechanical valves are made of materials which are not likely to react with your body, such as titanium.
  • Tissue valves are made from treated animal tissue, such as valves from a pig.

Transcatheter aortic valve replacement (TAVR)
Plastic tubes (catheters) are inserted into the heart through various arteries. Using these tubes, an artificial valve is sited within the existing aortic valve. This procedure does not require open heart surgery.

Stretching the stenosed valve (balloon valvuloplasty)

  • This is an option that is sometimes considered. This also does not require open heart surgery.
  • A catheter is inserted into the main blood vessel in the top of the leg. It is passed up to the heart. The tip of the catheter is placed in the aortic valve opening. A balloon at the tip of the catheter is then inflated to stretch the narrowed valve.
  • However, for adult patients, balloon valvuloplasty tends to be used only in those who are unsuitable for valvotomy or valve replacement surgery. This is because the improvement in the flow across the valve (following balloon valvuloplasty) does not usually last for very long. Valvotomy or valve replacement surgery tends to give better long-term results.

Some cases are mild and cause no symptoms. If you develop symptoms they tend to become worse over the years. Medication may ease symptoms but cannot reverse a narrowed (stenosed) valve. Surgery is normally advised if you develop symptoms.
Surgical treatment has greatly improved the outlook (prognosis) in most people who have more severe stenosis. Surgery to widen or to replace the valve has a very good success rate. The outlook is good if the valve is treated before the heart becomes badly damaged.

Further reading and references

Celebrities and their heart problems

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