Aortic Valve Disorders
What are aortic valve disorders?
What are the symptoms of aortic valve disorders?
What causes aortic valve disorders?
How are aortic valve disorders diagnosed?
How can aortic valve disorders be treated?
The aorta, the body's main blood vessel, supplies oxygen-rich blood from your heart to every part of your body. Your aortic valve controls the flow of blood from your heart's left ventricle into your aorta; a valve is several little flaps of tissue that open and close each time your heart beats, sending the blood in the correct direction, out of your heart and into your aorta.
There are three major conditions that affect this valve:
- Aortic valve regurgitation, also called aortic valve insufficiency, which means the valve is leaky and allows blood to flow backward into the heart. ("Regurgitation" comes from Latin words meaning "to engulf again.")
- Aortic valve stenosis, which means the flaps of the valve have thickened, stiffened or stuck together and are thus unable to open completely; this partially blocks the flow of blood into the aorta. ("Stenosis" comes from a Latin word meaning "to make narrow.")
- Bicuspid aortic valve (BAV), which means the valve has just two flaps, rather than the normal three (the triangle-shaped flaps are also known as cusps, from the Latin word for "point" — so "bicuspid" means "having two flaps"). A BAV is the most common congenital heart defect. Bicuspid valves can become either blocked (stenotic) or leaky (regurgitant).
(There are also aortic disorders that affect the vessel itself, though they are often associated with damage to the aortic valve.)
In the U.S., about 150,000 people have aortic valve regurgitation, and about 250,000 people suffer from symptomatic aortic valve stenosis. Men have a higher risk than women of suffering aortic valve disease. A mildly damaged aortic valve can often be managed with medication, but a seriously damaged valve will usually require surgery.
Symptoms of a disease are indications that can be detected by the patient, such as pain or fatigue (while signs are indications that can be detected by a doctor, such as the results of a blood test or an X-ray). Sometimes a diseased aortic valve causes no symptoms. But sometimes the condition worsens and begins to cause symptoms.
The signs and symptoms of aortic valve regurgitation include a pounding, racing or uneven pulse; fainting; fatigue; palpitations (a fluttering sensation in your heart); shortness of breath; weakness, especially if it's brought on by exertion; swelling of the feet, legs or abdomen; and, in very rare cases, chest pain similar to that of angina.
The signs and symptoms of aortic valve stenosis include chest pain; fatigue or shortness of breath, especially if they're brought on by exertion; palpitations (a fluttering sensation in your heart); and a heart murmur (a "swooshing" sound perceptible through a stethoscope).
A BAV, although present from birth, often causes no symptoms until adulthood. If it does begin causing symptoms, they will likely include fatigue or shortness of breath, especially if they're brought on by exertion, and the other symptoms listed above for leaky or blocked aortic valves. In fact, a BAV may often become leaky or blocked.
If untreated, advanced aortic valve disease can eventually lead to congestive heart failure; a stroke; blood clots, which can lodge in a vital organ; or sudden cardiac arrest, which if not treated within minutes usually causes death.
Both aortic valve regurgitation and stenosis used to be most commonly caused by rheumatic fever, an inflammatory disease often triggered by the strep bacterium. However, antibiotics have made rheumatic fever much less common in the U.S. than in the past.
That means other factors are now more likely to cause leaky or blocked aortic valves, including aortic dissection; hypertension, or high blood pressure; endocarditis, an infection of the valves of the heart; ankylosing spondylitis, a form of arthritis; and systemic lupus erythematosus, an autoimmune condition.
As is the case with most congenital heart defects, including BAV, there is no way of knowing what caused the problem. Genetic factors are thought to be involved in some cases, however.
If a diseased aortic valve is symptomless, it may not require treatment. In some cases, though, a diseased aortic valve may be identified during a routine physical exam. For example, if your doctor detects signs such as a heart murmur (a "swooshing" sound perceptible through a stethoscope), an unusually forceful heartbeat, a hard pulse in your arms or legs, or fluid in your lungs, they may lead to a suspicion of aortic valve disease.
If such signs—or the presence of symptoms—cause your doctor to suspect that you may have a diseased aortic valve, certain diagnostic tests will likely be conducted. They may include an echocardiogram (an ultrasound image of your chest); a stress test; an MRI of your heart; or an aortic angiogram (also referred to as cardiac catheterization), which uses opaque dye to image your cardiovascular system.
There are no current medications that can cure aortic valve regurgitation or stenosis. However, if such disorders are mild, medication may relieve many symptoms and delay the development of complications, such as heart failure or stroke. Lifestyle changes (such as not smoking and staying active) can also lessen your symptoms and delay the development of complications.
In the case of a seriously leaky or blocked aortic valve, however, surgery may be indicated. While there are risks to surgery, which need to be balanced against the risks that your valvular disease will progress, surgery usually fixes the damaged valve and relieves all symptoms.
If a BAV causes symptoms severe enough that treatment is required, medication may relieve some of the symptoms. In many cases, however, surgical repair or replacement of the defective valve will be the most appropriate option.
Page reviewed on: Jun 26, 2015
Page reviewed by: Jock McCullough, MD
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