Aortic Valve Stenosis

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Aortic valve (AV) stenosis, or aortic stenosis, occurs when the heart's aortic valve narrows and prevents the valve from fully opening. This reduces or blocks blood flow from the heart into the aorta, the main artery to the body. When blood flow is reduced or blocked, the heart must work harder to pump blood to the body and, eventually, the amount of blood the heart can pump becomes limited. This can cause symptoms and possibly weaken the heart muscle. Treatment depends on the severity of stenosis and surgery may be required to repair or replace the valve. Left untreated, stenosis can lead to serious heart problems.

Symptoms

AV stenosis ranges from mild to severe. Signs and symptoms generally develop when there is severe narrowing of the valve. Signs and symptoms of AV stenosis may include:

• Heart murmur (abnormal heart sound)
• Angina (chest pain) or chest tightness with activity
• Faintness or dizziness with activity
• Shortness of breath, especially during or following activity
• Fatigue, especially during times of increased activity
• Heart palpitations (rapid, fluttering heartbeat)
• Lack of appetite (mainly in children)
• Low weight gain (mainly in children)

The heart-weakening effects of stenosis may lead to heart failure; signs and symptoms include fatigue, shortness of breath, and swollen ankles and feet.

Causes

In AV stenosis, the valve between the left ventricle (lower left heart chamber) and the aorta (main artery) that delivers blood to the rest of the body is narrowed. Since the left ventricle has to work harder to pump a sufficient amount of blood to the rest of the body, it walls can thicken and enlarge. Eventually, the extra effort can weaken the left ventricle and the rest of the heart, and can ultimately lead to heart failure and other problems.

AV stenosis can occur due to many causes, including:

• Congenital heart defects → Some children are born with an aortic valve that has only two cusps (bicuspid) instead of three (tricuspid). This defect may begin to cause issues adulthood, at which time the valve may need to be repaired or replaced.
   
• Calcium buildup on the valve → Heart valves may accumulate deposits of calcium from the blood, as a part of aging. It could potentially result in stiffening of the cusps of the valve, which narrows the aortic valve in older people. It usually doesn't cause symptoms until ages 70 or 80.
   
• Rheumatic fever → Rheumatic fever may result in scar tissue forming on the aortic valve, which can cause narrowing of the AV. The scar tissue can also create a rough surface on which calcium deposits can collect. 

Risk Factors

Risk factors of aortic valve stenosis include:

• Older age
• Congenital heart disease (eg. bicuspid aortic valve)
• History of infections that affect the heart
• Diabetes, high cholesterol and high blood pressure
• Chronic kidney disease
• History of chest radiation therapy

Minimally Invasive Treatment Options

• Transcatheter Aortic Valve Implantation (TAVI)
• Aortic Valve Replacement (AVR) via Mini-Thoracotomy
• Aortic Valve Replacement (AVR) via Mini-Sternotomy

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