Aortic valve disease

In aortic valve disease, the aortic valve (the most important output valve of the heart) does not work as efficiently as it used to, limiting blood flow through it, thus putting extra strain on the heart.

The aortic valve is vulnerable to disease, particularly as you grow older. It can cause uncomfortable and distressing symptoms including chest pains, breathlessness and dizziness/blackouts. If untreated, aortic valve problems can result in severe complications, including heart failure, valve infection, life-threatening heart rhythm abnormalities and eventually death.

There is no medication that can treat aortic valve disease. Water tablets may ease some of the symptoms for a short period of time but eventually, they will stop working. The only way to treat aortic valve disease is by either replacing the aortic valve using open heart surgery or implanting a new one on top of the old one using a keyhole procedure called transcatheter aortic valve implantation (TAVI).

What is the aortic valve?

“The aortic valve is a small flap of tissue (consisting of normally three leaflets) on the left side of your heart between the left ventricle (the stronger chamber of the heart) and the aorta, the large vessel that carries oxygen-rich blood to the body,” explains consultant cardiologist, Dr Vasileios Panoulas.

“The aortic valve acts as a one-way gate, opening and closing as your heart beats. It opens to allow blood to flow out of the heart to supply blood and oxygen to the body, then closes to prevent backflow.”

What is aortic valve disease?

Aortic valve disease occurs when the valve isn’t working properly. Aortic valve problems can affect the flow of blood around your body. The heart has to work harder to pump enough oxygen-filled blood to supply your body’s needs, putting a strain on the organ.

Aortic valve disease can cause dizziness, tiredness, chest pain and breathlessness. However, many people with aortic valve disease have no symptoms, especially in the early stages.

There are two types of aortic valve disease:

• Aortic stenosis: In aortic stenosis, the aortic valve becomes stiff and narrowed, which obstructs blood flow from the left ventricle into the aorta.
• Aortic regurgitation: In aortic regurgitation, the aortic valve becomes leaky and allows blood to flow back into the heart’s left lower chamber. It is also known as aortic insufficiency

Aortic valve disease can be congenital (present at birth) or appear later in life due to other health problems.

How to diagnose aortic valve disease

Many people with aortic valve disease are unaware that they have a heart problem. You may have no symptoms or think that symptoms like tiredness or breathlessness are part of ageing or caused by something else. However, it’s vital to identify valve disease promptly so that a doctor can monitor your heart health and advise on treatment. The British Heart Foundation said:

‘Timely treatment is important because the risk of dying from valve disease is greater the longer the patient lives with it. It can also become severe and cause heart failure.’

Experienced doctors can pick up aortic valve disease by listening to your heart with a stethoscope. They may hear abnormal sounds when the blood flows through the damaged valve. These characteristic murmurs can indicate a valve problem. They may follow up with investigations; these could include:

• echocardiography: An echocardiogram or ‘echo’ test uses sound waves to visualise your heart. It is like an ultrasound used in pregnancy or to look at abdominal and pelvic structures

An echo produces moving images of the heart and shows whether the aortic valve is narrowed or leaky. It can also show how effectively the heart is pumping blood.

An echo can help your doctor diagnose aortic valve disease, evaluate the extent of the problem and plan the best treatment.

• ECG: An electrocardiogram records your heart’s rate, rhythm and electrical activity. The ECG picks up and records your heart’s electrical activity then prints it on paper. ECGs can be used to identify heart rhythm abnormalities, including atrial fibrillation, which is more common if you have aortic valve disease.
• cardiac MRI: Magnetic resonance imaging is a type of scan that can clearly visualise the area where the aorta meets the heart.
• CT aorta: Computed tomography can look into details of your valve size, type, extent of calcification and assess suitability for the TAVI procedure
• cardiac angiogram: The specialist introduces a fine, flexible tube into a blood vessel in your wrist artery or the artery at the groin area. They pass the tube along the blood vessels to the heart using X-ray guidance. They inject a dye and then take X-ray images to show the blood flowing through the heart and into the aorta

Aortic valve stenosis

“If you have aortic stenosis, the aortic valve becomes narrowed and obstructs the blood flow out of the heart. Aortic stenosis is the one of the most common types of valve disease in the UK and other industrialised countries,” explains Dr Panoulas.

Aortic stenosis most commonly develops when the valve gets stiff with a build-up of calcified deposits due to age. However, children may be born with aortic stenosis, or it can develop as a result of rheumatic fever and scarlet fever.

Rheumatic fever and scarlet fever develop following a streptococcal infection in the throat. The infection can spread and scar the aortic valve, narrowing it and increasing the risk of calcium deposits.

Aortic valve stenosis symptoms

If you have aortic stenosis, you may not notice any symptoms in the initial phases. However, as time goes by it can cause symptoms that may be worse when you exercise or exert yourself.

Symptoms include:

• dizziness
• fatigue
• chest pain that is worse on exertion
• palpitations – a feeling like your heart is skipping a beat, racing or beating too hard
• shortness of breath

When you have aortic stenosis, the left ventricle has to work harder to pump blood around the body. The muscle thickens and becomes stiffer. Over time the pressure in the left ventricle and lungs increases, and there is a risk of heart failure if the faulty valve is not treated or replaced. Complications of aortic stenosis include:

• atrial fibrillation: a fast, irregular heart rate
• cardiac arrhythmias: severe atrial stenosis can cause rhythm disturbances which can be dangerous and cause sudden death
• pulmonary hypertension
• heart failure: your heart can’t pump enough blood for your body’s needs. You will feel weak, tired and breathless. You may also develop swelling in the feet and ankles and congestion in the lungs, which causes breathlessness and coughing, which is worse when lying down
• endocarditis: as with all valve diseases, aortic stenosis increases your risk of developing endocarditis, a serious infection of the valve

Aortic valve stenosis treatment

Aortic valve stenosis treatment aims to relieve symptoms, improve quality of life and prolong life expectancy. If left untreated aortic stenosis will damage the heart over time and eventually lead to death. However, timely and successful treatment of aortic stenosis can allow people to live a normal life with good long-term survival.

Treatments include:

• palliative medication to treat symptoms: diuretics (water tablets) can reduce excess fluid in the lungs and treat breathlessness but their effectiveness will only be for a short period of time.
• balloon valvuloplasty: This minimally invasive procedure is used to relieve the blockage temporarily. The specialist introduces a fine, flexible tube into a blood vessel in your groin. They pass it to the heart using X-ray guidance. They inflate the balloon to open up the valve and improve blood flow. The effect of this procedure is only temporary and normally after 6 months the narrowing of the valve will return.
• surgical aortic valve replacement: Open heart surgery to replace the faulty valve is the definitive surgery for aortic stenosis. The surgeon removes the valve and replaces it with a prosthetic valve. There are minimally invasive options with smaller incisions on your chest.
• transcatheter aortic valve implantation or TAVI: A minimally-invasive procedure in which a new valve is inserted into your heart to treat aortic stenosis. TAVI was originally used for people who were too frail or high risk for invasive open-heart surgery. However following large studies the indication has expanded to intermediate and even some lower risk patients

Aortic valve regurgitation

“The aortic valve becomes leaky in aortic regurgitation and allows blood to flow back into the left ventricle from the aorta. It occurs when the aortic valve doesn’t close properly when the left ventricle relaxes after pumping blood out of the heart and around the body. Blood leaks, or regurgitates, back into the ventricle,” explains Dr Panoulas.

Common causes of aortic regurgitation are wear and tear associated with age, chronic hypertension and damage in a heart attack. More uncommonly, it can develop due to a heart valve infection, or diseases that also affect the big output vessel of the heart, the aorta (syphilis, Marfan’s syndrome and ankylosing spondylitis). Aortic regurgitation can also occur in children due to congenital abnormalities, although symptoms may not be apparent until adulthood.

Aortic regurgitation often develops gradually. However, it can come on suddenly if there is a tear in the aorta (dissection) or if the valve is infected. You may become acutely unwell and need emergency surgery to replace the damaged valve if this happens.

Aortic valve regurgitation symptoms

If you have aortic regurgitation, you may not notice any symptoms. However, it can cause symptoms, especially when the regurgitation is severe:

• Feeling dizzy and lightheaded.
• Tiredness.
• Chest pain that’s worse on exertion.
• Palpitations – a feeling like your heart is skipping a beat, racing or beating too hard.
• Shortness of breath that’s worse with exercise and lying flat.
• Foot and ankle swelling.

When you have aortic regurgitation, the left ventricle works harder to pump blood around the body. The muscle thickens, and the pressure in the left ventricle and lungs increases. Over time there is a risk of heart failure if the leaky valve isn’t replaced. Complications of aortic regurgitation include:

• cardiac arrhythmias: severe atrial regurgitation can cause rhythm disturbances which can be dangerous and cause sudden death
• heart failure: your heart can’t pump enough blood for your body’s needs. You will feel weak, tired and breathless. You may also develop swelling in the feet and ankles and congestion in the lungs, which causes breathlessness and coughing, which is worse on lying down
• endocarditis: as with all valve diseases, aortic stenosis increases your risk of developing endocarditis, a serious infection of the valve.

Aortic valve regurgitation treatment

If you don’t have any symptoms, you probably will not need treatment for your aortic regurgitation. If you have symptoms, you may need treatment, which could include:

• medication to treat symptoms: diuretics can reduce excess fluid in the body and treat breathlessness, and a range of hypertension medications can lower blood pressure, although beta-blockers should be avoided
• aortic valve repair: open heart surgery aiming to repair your own valve
• surgical aortic valve replacement: open heart surgery to replace the faulty valve is the most common surgery for aortic stenosis. The surgeon removes the valve and replaces it with a prosthetic valve
• transcatheter aortic valve implantation or TAVI: a minimally-invasive procedure in which a new valve is inserted into the existing valve. TAVI is sometimes used for patients with aortic regurgitation when they are too frail or too high risk for open heart surgery (even though this is an off-label indication).

Get in touch

For more information or to book an appointment, please contact our customer care team.