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What Is Aortic Valve Stenosis?
Aortic valve stenosis, also called aortic stenosis (AS), occurs when your aortic valve is too narrow. The narrowing is called stenosis.
Your aortic valve is where your heart meets your body's largest artery — the aorta. Your aortic valve pumps blood from your heart to the rest of your body through the aorta.
Your aortic valve has three parts, called flaps or leaflets.
In a healthy heart, when the left chamber squeezes, blood flows out of it. The flaps of the aortic valve open to let blood flow through.
When the heart relaxes, the flaps snap shut to prevent blood from flowing backward.
In AS, the valve doesn't open wide enough and limits blood flow from the heart into the aorta. In response, your heart works harder to pump enough blood to meet your body's needs.
Aortic stenosis is a serious condition. If left untreated, it can cause your heart to weaken and lead to heart failure.
At UPMC, we take a team-based approach to tailoring the right aortic valve stenosis treatment to your unique needs.
How common is aortic stenosis?
Aortic stenosis is the most common valve disease, affecting 2.5 million people in the U.S.
What are the stages of aortic stenosis?
Aortic stenosis has four stages: mild, moderate, severe, or critical. Your stage is determined by the level of damage in your valve and how much blood can pass through it.
The stages are:
- Mild – You are at risk for valve disease.
- Moderate – Your disease is progressing but moderate, and you have no symptoms.
- Severe – Your valve is damaged, but you don’t have obvious symptoms.
- Critical – Your symptoms are severe.
What causes aortic stenosis?
- AS is a common heart disease. It affects about 5 percent of people over the age of 70.
- Although it is sometimes present at birth, AS is more common in older adults.
- As you age, calcium deposits in your aortic valve can cause it to stiffen and not open correctly. This narrowing may lead to heart failure and a range of other issues.
- One to two percent of people are born with a bicuspid aortic valve, which has two flaps instead of three. This heart defect can lead to AS. Doctors often don't notice it in babies and growing children, so it may not cause problems until adulthood. Over time, the aortic valve may get tight or leaky.
What are aortic stenosis risk factors and complications?
Aortic stenosis risk factors
Factors that increase your risk of AS include:
- Age – It often occurs in people older than 65 years.
- Atherosclerosis – A disease caused by a buildup of plaque in the arteries, causing them to harden. This condition can accompany aortic stenosis.
- Bicuspid aortic valve – A condition in which the aortic valve has two flaps instead of three. This can cause the valve to leak or narrow.
- Diabetes – People with diabetes are more likely to get aortic stenosis because it may speed up plaque buildup in the arteries.
- High cholesterol – Having high cholesterol can cause inflammation and lead to aortic stenosis.
- Rheumatic fever – An infection that can cause scarring of the heart's valves.
- End-stage kidney disease – Aortic stenosis tends to progress more quickly in people with chronic kidney disease.
Complications of aortic stenosis
AS can lead to problems, such as:
- Endocarditis – This is a bacterial infection inside your heart. People with aortic stenosis have a harder time fighting the infection.
- Heart failure – Aortic stenosis makes the heart muscle work harder, weakening it over time and leading to heart failure. Look for symptoms, including fatigue, shortness of breath, and swelling of the legs, ankles, and feet.
How can I reduce my risks of aortic stenosis?
AS is a progressive condition.
Ways to reduce the risk of complications or slow progression, include:
- Avoiding recreational drugs.
- Controlling cholesterol and blood pressure.
- Eating a heart-healthy diet.
- Exercising regularly.
- Limiting alcohol.
- Maintaining a healthy weight.
- Managing diabetes.
- Quitting smoking.
See your UPMC heart doctor regularly. Ongoing follow-up care is vital to check your heart valve disease for possible progression.
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What Are the Signs and Symptoms of Aortic Stenosis?
The signs of aortic valve stenosis range from mild to severe. Many people don't notice symptoms of AS or only notice them during physical activity.
Signs of AS include:
- Chest pain, also called angina, which may feel like a tightness or burning sensation.
- Fatigue.
- Heart murmur.
- Heart rhythm problems, heart palpitations, fluttering heart, or rapid heartbeat.
- Lightheadedness, fainting, or shortness of breath with exertion.
AS can weaken the heart and lead to heart failure.
It can also cause daily health problems such as:
- Chest pain.
- Shortness of breath.
- Swollen ankles and feet.
What symptoms indicate worsening of aortic stenosis?
Symptoms that may indicate worsening aortic stenosis include:
- Ankle and foot swelling.
- Chest pain.
- Decreased exercise tolerance.
- Fainting or lightheadedness, especially during physical activity.
- Fatigue during increased activity.
- Heart palpitations.
- Shortness of breath, especially after physical activity.
- Sleep disturbance.
When should I see a doctor about my aortic stenosis symptoms?
You should see a heart doctor to treat your AS if you have any symptoms.
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How Do You Diagnose Aortic Stenosis?
Your doctor can detect AS by listening to your heart and hearing abnormal valve sounds called murmurs.
Your doctor may order tests to confirm the diagnosis. These tests may also diagnose other conditions such as heart rhythm problems or atherosclerosis.
Tests to diagnose aortic stenosis
- Electrocardiogram (ECG or EKG) – This test records the electrical activity of your heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and can sometimes detect heart muscle damage.
- Echocardiogram (ECHO) – This noninvasive ultrasound test uses sound waves to evaluate your heart's chambers and valves. The ECHO sound waves create an image on a monitor as an ultrasound transducer is passed over your heart.
- Cardiac catheterization – This diagnostic procedure involves the insertion of a tiny, hollow tube (catheter) through a large artery in your leg or arm leading to your heart to provide images of your heart and blood vessels. This procedure is helpful in determining the type and extent of certain valve disorders.
- Chest x-ray – A chest x-ray is a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. An x-ray can show enlargement in any area of the heart.
- Magnetic resonance imaging (MRI) – MRI is a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
What is the life expectancy of someone with aortic stenosis?
Aortic stenosis is a progressive disease that, left untreated, can reduce life expectancy. Your prognosis depends on how narrow your aortic valve is. If you have severe stenosis, your doctor may recommend a valve replacement. People who have valve replacements generally have extended life expectancy.
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How Do You Treat Aortic Stenosis?
Your heart doctor will design a treatment plan to control AS and any other health problems it may cause. Your plan may include:
Medicine
Drugs do not help AS itself, but they do treat other conditions and can help you feel better.
For instance, if you have symptoms of heart failure, your doctor may prescribe medicine to:
- Increase blood flow in your narrowed blood vessels.
- Prevent the buildup of excess fluids.
- Prevent the production of hormones that cause the heart to work harder.
Surgery to replace the aortic valve
Open heart surgery to replace aortic valves is the standard treatment for AS.
During surgery, your UPMC surgeon makes an incision in the middle of your chest and divides the breastbone in half.
This gives them access to your heart to remove your aortic valve and replace it with either a:
- Mechanical valve – This valve can last a long time, but you'll need to take a lifelong blood thinner to prevent blood clots.
- Tissue valve – These replacement valves don't last as long as mechanical valves, but you won't need to take blood thinners.
Other options for replacing your aortic valve include:
TAVR (transcatheter aortic valve replacement)
TAVR is a minimally invasive approach to replace your aortic valve through a small tube or catheter. Your doctor may suggest you have a TAVR procedure if you have severe aortic stenosis that causes symptoms, but you are not a candidate for open-chest surgery.
During TAVR, your surgeon:
- Makes a small incision in the groin and places the tube with the new valve in a blood vessel.
- Uses a special moving x-ray called fluoroscopy to guide the tube to your diseased aortic valve.
- Places the new valve inside your aortic valve and then removes the tube from your groin.
Which aortic valve replacement option is right for me?
Your UPMC team will recommend the most appropriate procedure based on your age, disease stage, and overall health.
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Why Choose UPMC for Aortic Stenosis Care?
When you choose UPMC for aortic stenosis care, you will benefit from:
- Our aortic stenosis treatment experience – Our surgeons have treated thousands of aortic valve stenosis patients and have one of the largest cardiothoracic surgery programs in the U.S.
- Our cardiac surgeons – Our cardiac surgeons have pioneered novel valve replacement procedures.
- Our minimally invasive treatment options – UPMC is among the most experienced, highest-volume TAVR centers in the U.S.
- Our commitment to research – Our structural heart team is at the forefront of emerging research on new techniques, devices, and approaches to treat valve disease.
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Last reviewed by a UPMC medical professional on 2024-10-01.
