Aortic Valve Disease Causes, Symptoms, Diagnosis, Treatment

Aortic Valve Disease Causes, Symptoms, Diagnosis, Treatment

What is aortic valve disease?

Aortic valve disease occurs when the aortic valve does not work correctly. There are two types of aortic valve disease: aortic stenosis and aortic regurgitation. Both affect the heart valve that regulates the flow of oxygenated blood from the heart to the rest of the body. The heart is made up of four chambers. The lower two chambers are called ventricles. Blood pumps from the heart into the left ventricle, then pumps into the main heart artery, the aorta where it is continues to pump into the rest of the body.

Aortic valve stenosis

These stiff, fused, thickened, inflexible valve leaflets lead to the narrowing of the aortic valve, that limits the blood flow. Aortic valve stenosis progresses when calcium is deposited on the valve leaflets, further limiting their mobility. Stenosis can occur in patients with either a tricuspid (3 leaflets) or a bicuspid (2 leaflets) aortic valve.

Aortic valve regurgitation (also called valvular insufficiency, incompetence or "leaky valve")

These valve leaflets do not close completely. Regurgitation causes the blood that is ejected by the heart to immediately flow back into the heart once the heart stops squeezing and relaxes. Regurgitation may occur because of floppy leaflets (prolapse), abnormal congenitally deformed valves (bicuspid or unicuspid), infection of the valve (endocarditis), inability of the leaflets to close tightly due to dilatation of the aorta (aneurysm), holes in the leaflets, or rheumatic valve disease.

What causes and rick factors of aortic valve disease?

Aortic valve disease can be congenital, or caused by a malformation that is present at birth. For example, some aortic valves do not have the normal three cusps or leafs, leaving them susceptible to damage and to calcium buildup on and around the valve.

Aortic stenosis can occur with age or because of atherosclerosis, or hardening of the arteries (acquired valve disease).

Congenital aortic valve disease

Patients with bicuspid aortic valves are born with them and are present in about 1 - 2 percent of the population.

Instead of the normal three leaflets or cusps, the bicuspid aortic valve has only two. Without the third leaflet, the valve opening may not close completely and leak (regurgitant) or not open completely and become narrowed (stenotic) or leak.

In many cases, bicuspid aortic valves may function normally for several years without requiring treatment.

About 25 percent of patients with bicuspid aortic valves may have some enlargement of the aorta above the valve. If it is greatly dilated, the aorta is known as being aneurismal.

Acquired aortic valve disease

With acquired aortic valve conditions, changes occur in the structure of the valve. Acquired aortic valve conditions include:

  • Infective endocarditis is a bacterial infection of the valve, which is caused when bacteria enter your blood stream from the site of a remote infection and attach to the surface of your heart valves. Dental cleaning or even minor infection, such as a tooth abscess, can cause severe bacterial endocarditis of the aortic valve.
  • Rheumatic fever is usually caused by a bacterial throat infection, such as strep throat. The valve itself is not infected in rheumatic fever, but antibodies developed by the body to fight infection react with the heart valves, causing stiffening and fusion of the leaflets of the aortic valve.
  • Aortic valve degeneration from wear and tear is another cause of acquired aortic valve disease. In many patients, the aortic valve leaflets degenerate and become calcified with time. This most frequently causes aortic stenosis, but may also cause aortic regurgitation. This is the most common cause of aortic stenosis in people over the age of 65.
  • Other causes of aortic valve disease include: rheumatoid arthritis, chronic inflammatory diseases, lupus, syphilis, hypertension, aortic aneurysms, connective tissue diseases, and less commonly, tumors, some types of drugs and radiation for cancers or lymphoma.

What are the symptoms of aortic valve disease?

Many patients with aortic valve disease are asymptomatic (have no symptoms), even when the stenosis (narrowing) or insufficiency (leak) are severe.

  • chest pain under the sternum, which may radiate; crushing, squeezing, pressure, tightness; pain increases with exercise, relieves with rest.
  • fainting
  • fatigue
  • irregular, rapid, racing, pounding or fluttering pulse
  • palpitations
  • pulse, pounding  
  • shortness of breath
  • weakness
  • Dizziness or loss of consciousness

How is aortic valve disease diagnosed?

During an examination, a physician diagnoses aortic valve disease while listening with a stethoscope for heart murmurs, or sounds of abnormal valve function that causes abnormal blood flow through the heart. The physician will confirm the diagnosis by ordering tests, including:
  • X rays;
  • Echocardiography; and
  • Cardiac catheterization and angiography.

How is aortic valve disease treated?

Medical management may be used in treating aortic valve disease, but only during a period of time when monitoring the disease is advised or when surgery is not an option. The only cure for aortic valve disease is valve repair or replacement.

Minimally Invasive Treatments for Aortic Stenosis

Balloon valvuloplasty is performed through a tiny tube (catheter) inserted into the heart through a blood vessel in the groin. Once the catheter reaches the affected valve, a balloon placed at the tip of the catheter is inflated. This stretches the valve open.

Surgical Treatment for Aortic Stenosis

Valvotomy removes the scar tissue on the flaps of the valve that restricts the valve’s ability to open and close properly.

Aortic valve replacement with either a biological valve made from the tissues and/or valves of animals, or a mechanical valve.

Pulmonary autograft removes a section of the patient’s pulmonary artery that includes the pulmonary valve. This section replaces the affected aortic valve. The removed pulmonary valve is replaced with a transplanted valve from a human donor.

Surgical treatment for aortic regurgitation

Heart valve repair may entail reforming valve tissue to make it open and close properly.

Heart valve replacement may be required in severe cases of damage or deformation of the heart valve. Heart valves can be replaced by tissue valves from animals or humans, or by valves made of plastic, metal or other synthetic material.

Medical Management

Medications to relax blood vessels include vasodilators, while medications to help the body rid itself of excess fluids and bring blood pressure down include diuretics.

Research and Clinical Trials for Aortic Valve Disease

Clinical trials are now underway to study the effectiveness of statin drugs in slowing or stopping the progression of aortic valve disease.