Aortic stenosis

About aortic stenosis 

Aortic stenosis is the abnormal narrowing of the aortic valve, which restricts the flow of blood from the bottom left chamber of the heart (the left ventricle) 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 

Symptoms of aortic stenosis

Aortic stenosis may have no symptoms (be asymptomatic) for many years. In people born with a valve abnormality, aortic stenosis can sometimes develop and is often diagnosed in teenage years.

Symptoms may also appear later in ife 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 of aortic stenosis include:

• congenital valve abnormalities – some people are born with 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 (fluid in the lungs) – the back pressure of blood inside the heart changes the pressure in the blood vessels of the lungs. This causes fluid build-up and breathing difficulties
• cardiomegaly (enlarged heart) – without treatment, the left ventricle may thicken and enlarge. This reduces the ventricle’s ability to pump blood
• heart failure – aortic stenosis compromises the functioning of the heart’s left side, but this can also impact on the right side of the heart in severe cases
• heart arrhythmia – an irregular heartbeat. Some arrhythmias in the ventricles can be life-threatening and need urgent treatment, 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 or wrist and threaded up to the heart). This can include left ventriculography, which includes using a dye so that the heart shows up more clearly on x-ray
• coronary angiogram to assess whether there is coronary artery disease in addition to the recognised aortic valve disease.

Treatment for aortic stenosis

Treatment for aortic stenosis may include:

• monitoring – for asymptomatic or mild cases
• 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
• procedures or surgery to replace or repair the valve.

Surgical procedures for aortic stenosis

There are three main surgical procedures for treating aortic stenosis:

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

Aortic valve replacement

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

Transcatheter aortic valve implantation (TAVI)

TAVI is a procedure that involves a new valve being inserted without the need for open heart surgery. It can also be known as transcatheter aortic valve replacement (TAVR). A TAVI or TAVR is usually only suitable for older people who are too high risk for conventional surgical replacement. 

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. 

The balloon is then deflated and it and the catheter are then removed.

Balloon valvuloplasty doesn’t cure the condition and further surgical treatment may be needed later in life. This procedure is usually used as a temporary measure or to relieve symptoms when other options are not available. 

Where to get help

• Your GP (doctor)
• Cardiologist
• Heart Foundation