Aortic valve stenosis

Your aortic valve keeps blood flowing from your heart’s lower left chamber (left ventricle) to the aorta, the main artery bringing blood from the heart to the body. Aortic stenosis occurs when the aortic valve narrows and blood cannot flow normally. The condition may range from mild to severe.

Over time, aortic valve stenosis causes your heart’s left ventricle to pump harder to push blood through the narrowed aortic valve. The extra effort may cause the left ventricle to thicken, enlarge and weaken. If not addressed, this form of heart valve disease may lead to heart failure.

You may have aortic stenosis and not experience symptoms for many years. However, symptoms may develop over time if your condition becomes more severe. Symptoms may include:

• Chest pain: you might feel tightness in your lungs and chest, especially with physical activity.
• Fatigue: you may feel extreme exhaustion during increased activity.
• Shortness of breath: you may have a hard time breathing deeply, especially after being active.
• Fainting or lightheadedness: you feel dizzy or even lose consciousness, especially during activity.
• Heart murmur: an abnormal heart sound your doctor can detect by listening through a stethoscope.
• Heart palpitations: an irregular heartbeat that feels like a rapid, fluttering sensation in your chest.

Aortic stenosis is most commonly caused by atherosclerosis, a calcium buildup on the aortic valve over time. These calcium deposits often come with age making the valve tissue stiff, narrow, and unyielding.

Though less common, there are several other causes of aortic stenosis including:

• Congenital heart conditions: if you were born with a heart defect, such as bicuspid aortic valve, your risk of developing aortic stenosis increases.
• Infective endocarditis: endocarditis is a bacterial infection of the heart valves, caused when bacteria from a remote infection enters the bloodstream.
• Rheumatic fever: this rare complication of strep throat may cause scar tissue to form on the aortic valve.

Aortic stenosis can be graded as mild, moderate, severe, or critical. The rate of progression will vary depending on your overall health, symptoms, the stage at which you are diagnosed, and when/if you receive treatment.

Though there is no definitive rate at which aortic stenosis will progress, certain risk factors may be associated with a quicker progression. These factors include:

• Age
• BMI
• Tobacco use
• High blood pressure

If your doctor suspects an aortic valve condition like aortic stenosis, they will use cardiovascular imaging techniques including:

• Transthoracic echocardiogram (TTE)
• Electrocardiogram (ECG)
• Exercise stress testing
• Magnetic resonance imaging (MRI)

Penn Medicine’s cardiovascular team creates an aortic stenosis treatment plan based on the severity of your diagnosis. If you are not experiencing symptoms, our cardiologists and imaging professionals monitor your condition. Your doctor may recommend medication or lifestyle changes to treat symptoms as they arise.

If your aortic valve stenosis is more severe, your cardiologist may determine that your aortic valve should be replaced or repaired. We treat aortic stenosis using both surgical and nonsurgical procedures including:

• Aortic valve replacement surgery, where cardiac surgeons remove the damaged valve through open-chest or minimally invasive heart surgery and replace it with a mechanical or biological valve (made from cow, pig, or human heart tissue).
• Balloon valvuloplasty, which is a catheter-based procedure, is used as a palliative treatment to improve symptoms of aortic stenosis when valve replacement is not an option.
• TAVR, or transcatheter aortic valve replacement, is an innovative, nonsurgical valve replacement procedure now used in place of traditional surgery in many patients.

Aortic stenosis can be caused by factors such as age and congenital heart defects, it can’t always be prevented. However, there are some lifestyle factors you can control to help maintain good heart health. Things you can do to help maintain a healthy heart and prevent aortic stenosis include:

• Eating a healthy diet
• Maintaining a regular exercise routine
• Don’t smoke or use illicit drugs
• Seeing your doctor for your annual well visit or as needed
• Keeping conditions like high blood pressure, diabetes, high cholesterol and kidney problems under control
• Visiting your dentist every six months and maintaining good oral health to prevent endocarditis
• If you suspect you have strep throat, see your doctor to prevent rheumatic fever