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Aortic Valve Stenosis: Causes, Symptoms & Treatment
Aortic valve stenosis is a narrowing of the heart valve between the left ventricle and the aorta. It restricts blood flow and places lasting strain on the heart.
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Aortic valve stenosis is a narrowing of the heart valve between the left ventricle and the aorta. It restricts blood flow and places lasting strain on the heart.
What Is Aortic Valve Stenosis?
Aortic valve stenosis (or aortic stenosis) is one of the most common heart valve diseases in the Western world. It describes a narrowing of the aortic valve – the valve located between the left ventricle and the main artery (aorta). In a healthy heart, this valve opens and closes with each heartbeat to direct blood flow in one direction. In stenosis, the opening area of the valve is pathologically reduced, forcing the heart to work harder to pump blood into the body.
Causes
Aortic valve stenosis can develop for several reasons:
- Degenerative calcification (most common form): With advancing age, calcium deposits build up on the valve leaflets, causing them to harden and stiffen. This form primarily affects people over the age of 65.
- Congenital bicuspid aortic valve: Normally, the aortic valve has three leaflets (tricuspid). Some people are born with only two leaflets (bicuspid), which leads to earlier wear and tear.
- Rheumatic fever: A complication of streptococcal infections can damage and scar the heart valves.
Symptoms
In the early stages, aortic valve stenosis often causes no symptoms. As the narrowing progresses, the following symptoms may appear:
- Exertional dyspnea: Shortness of breath during physical activity
- Angina pectoris: Chest pain or a feeling of pressure, especially under exertion
- Syncope: Brief episodes of fainting or dizziness
- Heart failure: In advanced stages, the heart can no longer supply the body with enough blood, leading to swelling (edema), fatigue, and reduced exercise capacity.
The classic triad of chest pain, syncope, and heart failure is an important warning sign for severe aortic stenosis.
Diagnosis
Aortic valve stenosis is diagnosed through several examinations:
- Cardiac auscultation: The physician listens with a stethoscope for a characteristic heart murmur (systolic murmur).
- Echocardiography (cardiac ultrasound): The most important diagnostic tool. It visualizes valve structure, the severity of the stenosis, and overall heart function.
- ECG (electrocardiogram): May show signs of thickening of the heart wall (left ventricular hypertrophy).
- Chest X-ray: Shows heart size and possible signs of pulmonary congestion.
- Cardiac catheterization: Used when findings are unclear or for pre-operative planning.
Severity is classified based on the valve opening area and the pressure gradient across the valve: mild, moderate, and severe.
Treatment
As long as no symptoms are present, regular follow-up examinations are sufficient. In cases of severe or symptomatic aortic stenosis, valve replacement is necessary.
Surgical Aortic Valve Replacement (SAVR)
Surgical aortic valve replacement (SAVR) is the standard treatment for younger patients who are suitable for open-heart surgery. The diseased valve is replaced with a mechanical or biological prosthetic valve.
Transcatheter Aortic Valve Implantation (TAVI)
For older or high-risk patients, TAVI (Transcatheter Aortic Valve Implantation) is used. A new valve is delivered via a catheter – usually through the femoral artery in the groin – and implanted without open-heart surgery.
Medical Therapy
Medications cannot reverse the stenosis itself, but they help manage accompanying conditions such as heart failure or arrhythmias and improve quality of life.
Prognosis and Course
Left untreated, severe symptomatic aortic stenosis carries a poor prognosis: without intervention, the median survival after the onset of symptoms is only a few years. Following successful valve replacement, life expectancy improves significantly, and most patients experience considerable relief of their symptoms.
References
- Vahanian A. et al. - 2021 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal, 2022; 43(7): 561–632.
- Otto CM et al. - 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation, 2021; 143(5): e72–e227.
- Bonow RO et al. - Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Elsevier, 2022.
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