What is the aortic valve and what is aortic stenosis?
The aortic valve is a heart valve that lies between the left ventricle and the aorta. The aorta is the main artery that takes blood from the heart to the body. The aortic valve has three flaps (cusps). Blood flows through the valve when the left ventricle squeezes (contracts) at the early part of the heartbeat. When the left ventricle relaxes, the aortic valve closes. Then the mitral valve opens to allow more blood into the ventricle ready for the next heartbeat.
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. Learn more about aortic regurgitation.
What are the treatments for aortic stenosis?
If the narrowing (stenosis) is mild and you have no symptoms then you may not need any treatment. If you develop symptoms or complications, various medicines may be advised to ease the symptoms. However, surgery is usually 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 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.
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.
What is the outlook for people with aortic stenosis?
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
Nishimura RA, Otto CM, Bonow RO, et al; 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2017 CIR.0000000000000503. Originally published March 15, 2017.
2015 ESC Guidelines for the management of infective endocarditis; European Society of Cardiology (Aug 2015)
Vahanian A et al; Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology, 2017.
Ozkan M; What is new in ACC/AHA 2017 focused update of valvular heart disease guidelines. Anatol J Cardiol. 2017 Jun17(6):421-422. doi: 10.14744/AnatolJCardiol.2017.7925.
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