The aortic valve is the valve at the top of the heart that lets the blood flow from the left ventricle (the main pumping chamber of the heart) to the aorta, (the body’s main artery) which supplies the body. Two things can go wrong with the valve - narrowing (stenosis) or leakiness (regurgitation).
Symptoms can include chest pain, shortness of breath and sometimes blackouts and dizziness. Sometimes there may be no symptoms but a doctor may hear a murmur (turbulent flow) when they listen to your heart with a stethoscope.
The treatment depends on the type and severity of the problem. If a procedure is required, it can usually be treated with either open-heart aortic valve surgery or transcutaneous aortic valve insertion, which is a minimally invasive procedure and allows quicker recovery.
There are two types of aortic valve disease:
Aortic stenosis occurs when the cusps (parts) that make up the valve become thickened and fused together and therefore unable to move apart to let blood through. When the valve thickens and becomes narrow, it limits the amount of blood that flow that can flow from the the heart to the aorta and then on to the rest of the body. The heart muscle tries to compensate for this by pumping more strongly, but if the valve is left untreated the heart muscle eventually beings to fail. It is therefore important that aortic stenosis is assessed promptly and thoroughly by a cardiologist.
Aortic regurgitation occurs when the aortic valve does not close properly, thereby causing the blood pumped out by the heart to flow back in to the left ventricle. This means the heart has to work harder than previously to pump more blood forward. The heart is able to compensate for some time with this approach, but if the regurgitation is severe enough over time the heart becomes enlarged and the starts to fail. Like aortic stenosis, it is therefore important that aortic regurgitation is assessed promptly and thoroughly by a cardiologist.
There are 4 valves in the heart that directs the flow of blood. These valves are the aortic valve, the pulmonary valve, the mitral valve and the tricuspid valve. Every valve has its flaps (also called leaflets or cusps) that opens and closes in accordance with each heartbeat. If this valve has difficulty opening or closing properly, the normal blood flow to your body will be disrupted, and its ability to circulate the needed amount of blood will be impaired.
Aortic valve disease may have an underlying cause, and one of them can be a congenital heart defect (a defect present at birth) or as a result of some age-related changes like high blood pressure, infection or heart injury.
The symptoms of aortic valve may be minimal unless the valve is severely affected and has been so for some time. However, the symptoms tend to become more pronounced as the disease progresses and include:
Some people are born with a congenital abnormality of the aortic valve and this can cause problems in childhood. This may be due to the valves not having the correct amount of parts. However, in most patients the valve has the normal number of parts (three) and becomes gradually more thickened and abnormal. The risk factors for this include.
Aortic valve disease may be suspected after the doctor reviews the details of your medical history or examines you and hears a murmur. The key investigation is to undergo an echocardiogram which is safe and painless and uses ultrasound to take pictures of the valve and measure the blood flow passing through the valve.
Depending on what the echocardiogram shows, you may also need other investigations such as an MRI scan of the heart to investigate the heart function, wall thickness and shape of the aorta, and a CT scan to help plan treatment by assessing the aorta and blood vessels around the heart and the coronary arteries since narrowings of the arteries may occur in patients with aortic valve disease.
The treatment that will be offered to you will depend on the type and severity of your condition. In some cases where you have no symptoms, your valve problem will not need any treatment yet and can be monitored annually or every six months to decide when treatment is required if at all.
If your valve problem is severe or is causing symptoms then you are likely to need treatment – this can be either open heart surgery or a transcatheter aortic valve implantation. Which is best for you requires careful discussion and your expert cardiologist will review all your tests and discuss with you the best way forward.
Abnormalities of the aortic valve can be complicated and needs expert assessment by qualified and experienced Consultant Cardiologists. Our Consultant Cardiologists are available for consultation on any day of the week and weekends as well.
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