Aortic Stenosis

In aortic stenosis, the opening of the aortic valve narrows.

Aortic stenosis is the most common heart valve disorder among older people. In this disorder, the heart—specifically, the left ventricle—has to work harder to pump blood through the valve into the aorta and to pump enough blood to the brain and other vital organs. Pressure increases in the left ventricle. Conditions that lower blood pressure, such as dehydration, can make pumping enough blood even harder. Aortic stenosis develops gradually. It can lead to serious heart problems and, if untreated, to death.

Causes

In older people, the most common cause of aortic stenosis is the accumulation of calcium (calcification) on a normal valve or on a valve that was mildly defective at birth. For example, an aortic valve may have two leaflets (called bicuspid) rather than the usual three. Calcium makes the valve stiff and narrows the opening.

Sometimes calcium accumulates on the aortic valve but does not interfere with blood flow. This disorder is called aortic sclerosis.

Symptoms and Diagnosis

Many people with aortic stenosis do not have symptoms. When symptoms develop, they may be mild at first and may be mistakenly attributed to getting older.

Usually, symptoms first occur during physical activity, when the demands on the heart are greater. People may become short of breath, feel faint, or actually faint. They may also have a feeling of tightness, heaviness, or pain in the chest (angina). Severe aortic stenosis can lead to heart failure and sometimes death without warning.

Doctors usually base the diagnosis on abnormal heart sounds, abnormalities in the pulse, and the results of echocardiography. Echocardiography can help doctors determine how narrow the valve's opening is.

Treatment and Outlook

Usually, if aortic stenosis does not cause any symptoms, people do not need treatment. However, they should see their doctor regularly and avoid overly stressful physical activity. They should also avoid becoming dehydrated. The doctor uses echocardiography to monitor the progression of the disorder.

If the valve's opening has become greatly narrowed or if symptoms develop, doctors almost always recommend surgery to replace the aortic valve. In these cases, the risk of surgery is almost always less than the risk of not having surgery. Before surgery in older people, cardiac catheterization is usually done to determine whether coronary artery disease is also present. If it is, coronary artery bypass graft (CABG) surgery is done at the same time.

If surgery is done, symptoms are greatly relieved or even eliminated. People can function much better and can usually avoid further hospitalization.

See the sidebar What is Aortic Sclerosis?