Aortic stenosis

Is the disease of the heart valves. When blood leaves the heart, it flows through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This decreases blood flow from the heart.

Causes

Aortic stenosis is most commonly caused by age-related progressive calcification of the normal tricuspid aortic valve (>50% of cases). Other causes include calcification of a congenital bicuspid aortic valve (30-40% of cases) and acute rheumatic fever (less than 10% of cases).

Aortic stenosis may be present from birth (congenital), or it may develop later in life (acquired). Children with aortic stenosis may have other congenital conditions.

Only rarely do other factors lead to aortic stenosis in adults. These include calcium deposits forming around the aortic valve, radiation treatment to the chest, and some medications.

Aortic stenosis is not common. It occurs more often in men than in women.

Symptoms

People with aortic stenosis may have no symptoms at all until late in the course of the disease. The diagnosis may have been made when the healthcare provider heard a heart murmur and then performed additional tests.
Symptoms related to aortic stenosis depends on the degree of valve stenosis. Most people with mild to moderate aortic stenosis do not have symptoms. Symptoms usually are manifest in those with severe aortic stenosis, although they can exist in those with mild to moderate severity as well. The initial presenting symptoms include progressive shortness of breath on exertion, which may be so subtle that they are not consciously aware, but may inadvertently cut down on exertional activities. More worrisome symptoms include syncope, chest pain, and frank heart failure.

Children with mild or moderate aortic stenosis may get worse as they get older. They also run the risk of developing a heart infection (bacterial endocarditis).

Diagnostic Procedure
The following tests may be performed:

• Chest x-ray
• Doppler echocardiography
• ECG
• Exercise stress testing
• Left cardiac catheterization
• MRI of the heart
• Transesophageal echocardiogram (TEE)

Treatment

Treatment is generally not necessary in asymptomatic patients. In moderate cases, echocardiography is performed every 12 years to monitor the progression, possibly complemented with a cardiac stress test. In severe cases, echocardiography is performed every 36 months.

In adults, symptomatic aortic stenosis usually requires aortic valve replacement, which decreases the risk of death.

Prognosis

Without surgery, a person with aortic stenosis who has angina or signs of heart failure may do poorly.

Aortic stenosis can be cured with surgery. After surgery there is a risk for irregular heart rhythms, which can cause sudden death, and blood clots, which can cause a stroke. There is also a risk that the new valve will stop working and need to be replaced.

Possible Complications

• Arrhythmias
• Endocarditis
• Left-sided heart failure
• Left ventricular hypertrophy (enlargement) caused by the extra work of pushing blood through the narrowed valve

Prevention

Treat strep infections promptly to prevent rheumatic fever, which can cause aortic stenosis. This condition itself often cannot be prevented, but some of the complications can be prevented.

Follow the health care provider’s treatment recommendation for conditions that may cause valve disease. Notify the provider if there is a family history of congenital heart disease.