Aortic valve disease and surgery
Diseases of the heart valves are grouped according to which valve or valves are involved and the amount of blood flow that is disrupted by the problem. The most common and serious valve problems happen in the mitral and aortic valves.
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The aortic valve regulates the blood flow from the heart's lower-left chamber (the left ventricle) into the aorta. The aorta is the main vessel that supplies blood to the rest of the body. Two main diseases can affect the aortic valve — aortic regurgitation and aortic stenosis.
Aortic regurgitation, or aortic insufficiency or aortic incompetence, is when blood flows backward from a widened or weakened aortic valve into the heart's lower chamber (the left ventricle). In the United States, the most serious form of this disease is caused by an infection that leaves holes in the valve leaflets.
Causes of aortic regurgitation
Aortic regurgitation is most common in men between the ages of 30 and 60. In adults, the most common cause of severe aortic regurgitation is rheumatic fever. Mild cases are often caused by a bicuspid aortic valve (where the valve has two leaflets instead of three) and severe high blood pressure (a diastolic pressure more than 110 mm Hg). Other causes, though rare, may include:
Ankylosing spondylitis (arthritis of the spine)
Aortic stenosis, a narrowing of the aortic valve that often causes some degree of aortic regurgitation
Dissecting aortic aneurysm
Endocarditis
Marfan syndrome, a connective tissue condition where patients have long bones and very flexible joints
Symptoms of aortic regurgitation
Like other valve defects, symptoms may not appear for years. When they do appear, they can come on slowly or suddenly. Symptoms begin because the left ventricle has to work harder. In time, the ventricle gets larger and fluid backs up. Symptoms may include:
Chest pain that gets worse with exercise and goes away with rest
Fast or fluttering pulse
Fatigue
Shortness of breath
Swelling in the ankles
Severe cases can lead to heart failure. In most of these cases, the aortic valve will eventually need to be replaced to fix the backflow of blood into the left ventricle.
Aortic stenosis is a narrowing or blockage of the aortic valve, which happens when the valve leaflets become coated with deposits. The deposits change the shape of the leaflets and reduce blood flow through the valve. The left ventricle has to work harder to make up for the reduced blood flow, which can weaken the heart muscle over time.
Causes of aortic stenosis
Aortic stenosis is more common in men. Congenital defects (those you are born with) and rheumatic fever are the main causes of aortic stenosis in people under 50.
In some cases, people are born with a bicuspid aortic valve, meaning the valve has two leaflets instead of three, which may also cause aortic stenosis.
In elderly patients, calcium deposits and the growth of fibrous tissue on the aortic valve can distort the leaflets or cause them to fuse together. This is called calcification, and it can make the different leaflets almost look like a single leaflet.
Other causes include a history of other valve diseases, coronary artery disease or a heart murmur.
Symptoms of aortic stenosis
People with aortic stenosis may not have symptoms for years. When symptoms do appear, they may include:
Angina-like chest pain that gets worse with exercise and goes away with rest
Coughing
Fainting, especially during exercise
Heart palpitations (the feeling that the heart has skipped a beat)
Shortness of breath
Patients who have aortic stenosis are advised not to exercise too hard. Those with mild aortic stenosis may not need further treatment beyond regular doctor visits. Surgery to replace the valve is the treatment of choice for people with severe aortic stenosis.
How aortic valve surgery works
Cardiothoracic surgeons perform aortic valve replacements with "open heart" surgery. During this procedure, an incision is made down the middle of the breastbone (called a sternotomy) to provide direct access and visualization to the heart.
During surgery the patient is placed on a heart-lung bypass machine to oxygenate the blood while the heart is stopped to safely replace the valve.
Once the valve is replaced the chest cavity is closed and the patient recovers in the hospital for about five days. The procedure takes between two and four hours to complete.
Transcatheter aortic valve replacement is a minimally invasive and innovative treatment option. This procedure allows interventional cardiologists to replace a diseased aortic heart valve by placing a balloon-expandable heart valve into the body through a catheter inserted through a small incision.