Aortic valve stenosis, or simply aortic stenosis, is a serious heart condition involving a narrowing of the aortic valve, the "gateway" through which oxygenated blood passes from the heart to the rest of the body. As a result of this narrowing, the heart must work harder to pump blood out and gradually grows weaker over time, which could lead to heart failure and possibly death.
- What Is the Aortic Valve?
- What Causes Aortic Stenosis?
- What Are the Symptoms of Aortic Stenosis?
- Treatments for Aortic Stenosis
What Is the Aortic Valve?
The aorta is the largest artery of the body, the vessel through which oxygenated blood flows from the heart into the vascular system. The aortic valve is located between the left ventricle and the aorta; like all heart valves, it is there to ensure that blood flows in the right direction.
In a normal human heart, the aortic valve is made up of three thin flaps, also called leaflets or cusps. In about 1% of the population, the aortic valve has only two leaflets, a congenital defect known as bicuspid aortic valve.
What Causes Aortic Stenosis?
Several factors can cause the narrowing of the aortic valve that we call aortic stenosis:
- Calcium Buildup: The most common cause of aortic stenosis in people over 65 is a buildup of calcium that can make the leaflets hard and thick over time. The risk factors for this buildup are much the same as those for hardening of the arteries (atherosclerosis): high blood pressure, diabetes, smoking and high cholesterol.
- Bicuspid Aortic Valve: In people born with a birth defect known as bicuspid aortic valve, the valve is already narrowed because it consists of two flaps instead of the normal three. This condition may cause no complications until adulthood, when the valve may become too narrow to handle a normal volume of blood flow.
- Rheumatic Fever: Rheumatic fever in childhood or early adulthood can cause scarring on the aortic valve, which may restrict blood flow.
What Are the Symptoms of Aortic Stenosis?
Symptoms of aortic stenosis can include:
- Chest pain or tightness
- Feeling faint or weak
- Shortness of breath
By the time the symptoms of aortic stenosis become noticeable, the condition is usually serious. If you experience any of the above, especially during or just after physical exertion, please contact your doctor immediately.
Treatments for Aortic Stenosis
While medications may be used to manage some of the symptoms of aortic stenosis such as irregular heartbeat, the only way to treat the condition is by repairing or replacing the valve to open the passageway.
Open-Heart Surgical Valve Replacement
Traditionally, all valve replacements have been performed via open-heart surgery in which the surgeon removes the damaged valve and replaces it with an artificial valve. About one-third of aortic stenosis patients cannot receive replacements because the risk open-heart surgery is too high given their conditions.
Aortic stenosis patients who are not healthy enough for open-heart surgery may undergo balloon valvuloplasty to open up the aortic valve. A catheter with a small balloon in the tip is inserted into an artery in the arm or groin and navigated to the aortic valve, where it is inflated to push the valve open. Because the resulting expansion is temporary, balloon valvuloplasty is not considered a substitute for valve replacement.
Trans-Catheter Aortic Valve Implantation/Replacement (TAVI/TAVR)
Trans-catheter aortic valve implantation (TAVI, also called trans-catheter aortic valve replacement or TAVR) allows the aortic valve to be replaced through a small incision in the groin. The surgeon introduces a catheter carrying a new valve in a "crumpled" form and delivers it to the position of the natural aortic valve. When the new valve is in place, either it can be expanded with a balloon or it can be self-expanding.
The heart team at the Houston Methodist DeBakey Heart & Vascular Center are leaders in performing TAVI, and ours is one of the few centers selected to offer the new Edwards SAPIEN transcatheter heart valve. The Sapien can help restore normal blood flow in the heart in patients with aortic valve stenosis who would otherwise need open-heart surgery to replace the damaged and/or diseased valve, but for whom such a procedure is too risky. Our surgeons perform more TAVI procedures than any other center in the Houston area, and more than many major heart centers in the United States.
Houston Methodist DeBakey Heart & Vascular Center has been selected to participate in several clinical trials to study new treatments for aortic stenosis and continue our mission in Leading Medicine.
Information about our current clinical trials is available on the Houston Methodist DeBakey Heart & Vascular Center Clinical Trials page.
Learn more about valve disease:
- What Is Valve Disease
- What Causes Valve Disease?
- How Is Valve Disease Diagnosed?
- Symptoms of Valve Disease
- Treatments for Valve Disease
For more information about valve disease or to make an appointment, please call 713-441-2863 or complete the Contact Us online form.