Summary

  • The aortic valve opens when the heart contracts to allow the passage of blood from the left ventricle into the aorta, the body’s main artery. 
  • Aortic stenosis is the abnormal narrowing of the aortic valve, which restricts the flow of blood from the ventricle into the aorta.
  • Aortic stenosis can be a serious and potentially life-threatening condition.
  • Treatment options include medications to prevent heart failure and surgery to repair or replace the faulty valve.

Aortic stenosis is the abnormal narrowing of the aortic valve, which restricts the flow of blood from the left ventricle of the heart into the aorta.

The aortic valve opens when the heart contracts to pump oxygenated blood from the left ventricle into the aorta, the body’s main artery. If this valve is narrowed, it means that the heart can no longer pump blood efficiently – it needs to work harder to pump blood around your body. It also creates high blood pressure inside the left ventricle. 

In response to the extra workload, the muscle of the left ventricle thickens (concentric hypertrophy) and the chamber itself may eventually balloon out. 
Without treatment, death from congestive heart failure is possible. Around four in every 1,000 people are thought to have aortic stenosis.

 

Symptoms of aortic stenosis

Aortic stenosis may have no symptoms (be asymptomatic) for many years. This is why the condition, which may have been congenital (present from before birth), is often diagnosed during teenage years. Symptoms may appear later in life after decades of gradual progressive narrowing of the aortic valve. The onset of symptoms may be gradual or abrupt and may include:

  • breathlessness
  • breathing problems worsened by physical activity
  • coughing at night when lying down in bed
  • fainting
  • heart palpitations
  • pains in the chest, from the heart (angina)
  • fatigue
  • visual problems.

 

Causes of aortic stenosis

Some of the causes include:

  • congenital heart disease – the baby is born with heart abnormalities. For example, the aortic valve may be smaller than it should be
  • valve abnormalities – some people are born with minor abnormalities of the aortic valve. Over time, these abnormalities may cause the valve to narrow
  • rheumatic heart disease – is a condition that can scar the aortic valve and narrow its opening
  • calcium deposits – a build-up of calcium can stiffen the aortic valve and interfere with its proper functioning. This is the most common cause of aortic stenosis in people aged 70 years and over.

 

Complications of aortic stenosis

Aortic stenosis can be a serious and potentially life-threatening condition. Some of the possible complications include:

  • pulmonary oedema – the back pressure of blood inside the heart changes the pressure in the blood vessels of the lungs. This causes congestion and breathing difficulties
  • cardiomegaly – without treatment, the left ventricle may thicken and enlarge. This reduces the ventricle’s ability to pump blood
  • congestive heart failure – aortic stenosis compromises the functioning of the heart’s left side. Congestive heart failure occurs when the right side of the heart also stops working properly
  • heart arrhythmia – is an irregular heartbeat. Some arrhythmias in the ventricles may be associated with cardiac death, such as ‘ventricular fibrillation’ – when the ventricles are reduced to quivering rather than beating. 

 

Diagnosis of aortic stenosis

Aortic stenosis is diagnosed using a number of tests including:

  • physical examination including listening to the heart with a stethoscope
  • chest x-ray
  • electrocardiogram (ECG) to monitor the heart rate and pick up any unusual rhythms and to assess thickening of the left ventricle
  • echocardiogram (ultrasound scan) of the heart to assess the functioning of the aortic valve and of the left ventricle
  • cardiac catheterisation (a slender tube is inserted into a blood vessel of the groin and threaded up to the heart)
  • left ventriculography, which includes using a dye so that the heart shows up more clearly on x-ray
  • coronary arteriography to assess whether there is coronary artery disease in addition to the recognised aortic valve disease.

 

Treatment for aortic stenosis

Treatment may include:

  • monitoring – for asymptomatic or mild cases
  • medications to prevent heart failure
  • hospitalisation – for moderate to severe cases
  • lifestyle patterns such as maintaining physical activity while avoiding hard physical exercise, control of weight and avoidance of smoking
  • surgery.

 

Surgical procedures for aortic stenosis

There are three main surgical procedures for treating aortic stenosis:

  • balloon valvuloplasty
  • aortic valve replacement
  • transcatheter aortic valve implantation (TAVI).

Balloon valvuloplasty

When performing balloon valvuloplasty, a catheter is inserted into a blood vessel in the groin and threaded up to the heart. The tip of the catheter is placed inside the aortic valve and then a balloon is inflated. This helps to stretch and widen the valve and improve blood flow into the aorta. 

Balloon valvuloplasty doesn’t cure the condition and further surgical treatment may be needed later in life. This procedure is usually limited to those with congenital aortic stenosis – usually in children or adolescents.

Aortic valve replacement

If the aortic valve is too damaged to be repaired, it may be surgically replaced with an artificial valve. This is known as aortic valve replacement. Sometimes, the person’s own pulmonary valve may be used. The latter is known as a pulmonary autograft or Ross operation.

Transcatheter aortic valve implantation (TAVI)

TAVI is a relatively new procedure that involves a new valve being inserted without the need for open heart surgery. It is usually only suitable for older people who are too high risk for conventional surgical replacement.

Where to get help

  • Your doctor
  • Cardiologist
References
  • Aortic stenosis, Cardiology Department, Royal Children’s Hospital, Melbourne. More information here.
  • Ren X, Aortic stenosis , 2016, eMedicine.com.au, USA. More information here.
  • Martínez GJ, Seco M, Jaijee SK, et al. 2014, ‘Introduction of an interdisciplinary heart team-based transcatheter aortic valve implantation programme: short and mid-term outcomes’, Internal Medicine Journal, vol. 44, no. 9, pp. 876–883. More information here.

More information

Heart

The following content is displayed as Tabs. Once you have activated a link navigate to the end of the list to view its associated content. The activated link is defined as Active Tab

Know your risks for heart disease

Heart attack warning signs and symptoms

Heart conditions

Tests and treatments

Content Partner

This page has been produced in consultation with and approved by: Heart Foundation

Last updated: February 2017

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.