Aortic Valve Disease

The aortic valve is one of the main valves in the heart. It is there to ensure that red blood (containing oxygen) passes in the right direction from the main pumping chamber (the left ventricle) to the main blood vessel (the aorta) and out to the rest of the body. The valve closes after every heart beat so blood that should be going to the body doesn’t leak back into the pumping chamber (left ventricle).

In aortic valve disease there is an abnormality of the aortic valve which means it doesn’t work properly. The aortic valve can be narrowed in which case it won’t open properly (aortic stenosis) or it may not close properly and leak blood backwards into the main pumping chamber (aortic regurgitation). In some cases the valve may be both narrowed and leaky in which case the problem can be described as “mixed” aortic valve disease.

Aortic stenosis (narrowing)

The normal aortic valve is a delicate structure with 3 leaflets which look like a clover leaf. In aortic stenosis the leaflets are either thickened or stuck together.

Treatment for aortic stenosis (narrowing)

In a severely narrowed valve pressure can build up in the main pumping chamber (left ventricle) which can eventually lead to permanent damage. When this happens the valve must be opened up. There are two ways this can be done.
  1. In some narrowed aortic valves (but not all) it is possible to stretch open the valve with a balloon introduced at a keyhole procedure called a “cardiac catheter”. Although this procedure can be effective at reducing the pressure on the pumping chamber it does not “repair” the valve and so eventually nearly all valves treated this way will need replacing. Many young adult patients who were born with an aortic valve abnormality have already had this procedure done as a child (or the same thing done by surgeon called “surgical valvotomy” before keyhole treatment was invented).
  2. An aortic valve can be replaced at open heart surgery. There are 3 different types of valve that can be used with each type having its advantages and disadvantages which you need to discuss with your cardiologist (there is a separate information sheet which deals with the surgical options for aortic valve replacement in detail).

Bicuspid aortic valve

About 2% of people have aortic valves that have 2 leaflets rather than the usual 3. These valves can function very well throughout life but do have a tendency to narrow and/or leak as people get older. As well as an abnormality with the valve people with biscupid aortic valves frequently have an abnormality of the wall of the main blood vessel (aorta) such that it can stretch with the risk of a tear once it gets beyond a certain size. Your cardiologist will monitor this by scanning your valve and the vessel.
Frequently patients with a biscuspid aortic valve can have other abnormalities in the heart such as main blood vessel narrowing (coarctation) or abnormalities of other valves.

Aortic regurgitation (leak)

A leaky aortic valve makes the pumping chamber of the heart work harder than normal. When the leak is severe the valve needs replacing to preserve the pumping chamber. Because stretching the valve with a balloon using a keyhole technique can make the leak worse the only option when the problem is severe enough to need treating is valve replacement (see above under aortic stenosis).

Other issues

  1. Ongoing care: All patients with aortic valve disease need long term follow up under a cardiologist with expertise in dealing with the condition. Young adult patients who were born with a heart problem are usually best cared for in a unit specialising in the care of this patient group. You will be monitored regularly, have heart scans (echo’s) and ECG’s and possibly other tests if you cardiologist thinks it is necessary
  2. Exercise: Regular exercise, to a moderate level, is encouraged. It is good for overall health and can also help to keep blood pressure lower / under control. Activities such as walking, cycling, and swimming are ideal and it is important to warm up and warm down slowly. Unless the valve is only slightly narrowed it is often best to avoid really intense cardiovascular exercise, for example distance running or sudden ‘bursts’ of strenuous activity (squash and sprinting for example); it is usually better to avoid power/weight lifting too. If you are not sure whether any sport/activity is okay for you to do, ask the adult congenital heart disease team caring for you for advice.
  3. Endocarditis: All patients with aortic valve disease are at risk of infection in the heart (endocarditis). It is important that you have good dental hygiene and you visit the dentist every 6-12 months. You no longer require antibiotics prior to dental treatment. Due to the increased risk of infection we would advise against body piercing and tattoos.
  4. Pregnancy: Although pregnancy can be a risk in patients with severe aortic valve narrowing, patients with milder narrowing or leak usually cope very well. There are many issues relating to pregnancy for patients with aortic valve problems and it is VERY IMPORTANT you discuss things with your cardiologist before deciding to start a family.

Adult Congenital Heart Team
Leeds General Infirmary