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Aortic Valve – Function, Diseases and Treatment

The aortic valve is one of the four heart valves and controls blood flow from the left ventricle into the aorta. It plays a vital role in the cardiovascular system.

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Things worth knowing about "Aortic Valve"

The aortic valve is one of the four heart valves and controls blood flow from the left ventricle into the aorta. It plays a vital role in the cardiovascular system.

What is the Aortic Valve?

The aortic valve (Latin: Valva aortae) is one of the four valves of the human heart. It is located between the left ventricle (left heart chamber) and the aorta, the largest artery in the body. Its main function is to direct blood flow in one direction – from the heart into the systemic circulation – while preventing backflow of blood into the heart chamber.

In a healthy state, the aortic valve consists of three crescent-shaped leaflets (semilunar cusps) made of elastic connective tissue. With each heartbeat, it opens to allow blood into the aorta and then closes again to prevent regurgitation.

Anatomy and Structure

In most people, the aortic valve has three cusps (tricuspid valve). In rare cases, it may be born with only two cusps – known as a bicuspid aortic valve, which is the most common congenital heart defect and can lead to long-term complications.

The three cusps are named: the left coronary cusp, the right coronary cusp, and the non-coronary cusp.
The coronary arteries, which supply the heart muscle itself with blood, arise near the attachment points of the valve cusps.

Function in the Cardiovascular System

The aortic valve opens and closes with every heartbeat – approximately 60 to 100 times per minute. It operates passively, meaning the pressure difference between the left ventricle and the aorta automatically controls its movement:

Systole (ejection phase): The left ventricle contracts, pressure rises, the aortic valve opens, and blood is pumped into the aorta.
Diastole (filling phase): The ventricle relaxes, pressure drops, and the aortic valve closes to prevent backflow into the chamber.

Diseases of the Aortic Valve

The aortic valve can be impaired by various conditions. The two most common aortic valve diseases are:

Aortic Stenosis

Aortic stenosis involves a narrowing of the valve, which restricts blood flow from the left ventricle into the aorta. Common causes include age-related calcification, a bicuspid valve, or prior rheumatic disease. Typical symptoms include shortness of breath on exertion, dizziness, chest pain, and fainting episodes.

Aortic Regurgitation

Aortic regurgitation (also called aortic insufficiency) occurs when the valve no longer closes completely, allowing blood to flow back into the left ventricle during diastole. This causes volume overload of the heart and can lead to heart failure over time. Causes include a bicuspid valve, high blood pressure, inflammatory conditions, or dilation of the aortic root.

Diagnosis of Aortic Valve Disease

Aortic valve conditions are typically diagnosed using the following methods:

Cardiac auscultation: A doctor listens for characteristic heart murmurs using a stethoscope.
Echocardiography (cardiac ultrasound): The primary imaging tool for assessing valve structure and function.
ECG and chest X-ray: Used to evaluate heart rhythm and heart size.
Cardiac catheterization: Used for inconclusive findings or pre-surgical planning.

Treatment of Aortic Valve Disease

Treatment depends on the type and severity of the condition:

Medical therapy: Can relieve symptoms and slow progression, but does not cure the valve disease itself.
Surgical aortic valve replacement: In severe cases, the valve is surgically replaced with an artificial prosthesis (mechanical or biological).
TAVI (Transcatheter Aortic Valve Implantation): A minimally invasive procedure in which a new valve is delivered via a catheter – particularly suitable for elderly or high-risk patients.

References

Herold, G. et al. – Innere Medizin. Self-published, Cologne, 2023.
Deutsche Gesellschaft fur Kardiologie (DGK) – Guidelines on the Management of Valvular Heart Disease, 2021. Available at: www.dgk.org
Vahanian, A. et al. – 2021 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal, 2022; 43(7): 561–632.

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