• Home
• About Us
  • About Alliance Heart
  • World-class Professionals
  • Procedures and Technology
  • Locations
  • Central Florida Health Alliance
• Physicians
• Services
  • Services Overview
  • Ambient Catheterization Lab
  • Heart Valve Surgery
• Heart Valve Information
  • Heart Valve Information
  • Heart Valve Treatment
  • Heart Valve Surgeries
  • Minimally Invasive Valve
  • Aortic Valve
  • Mitral Valve
  • Tricuspid Valve
  • Multiple Valve
  • Aortic Aneurysm
  • Atrial Fibrillation
  • Heart Tumors
  • Types of Artificial Heart Valves
• Surgeries
  • Minimally Invasive Valve
  • Aortic Aneurysms
  • Aortic Valve Disease
  • Transcatheter Aortic Valve Implantation (TAVI)
  • Mitral Valve Disease
  • Mitral Valve Repair
  • Multiple Valve Disease
  • Tricuspid Valve Disease

Related Links

• Aortic Stenosis
  • Treatment: Transcatheter Aortic Valve Implantation (TAVI)
  • Treatment: Aortic Regurgitation
• Surgery for Aortic Valve Disease
• «« Back to Heart Valve Information Overview

Aortic Stenosis

Aortic stenosis means that the aortic valve is too "narrow" or too "tight".  There are generally three causes of this problem.

• Congenital: Some people are born with an abnormal valve where the valve has only two leaflets instead of the normal three.  This bicuspid valve usually causes problems in younger patients, who have had a heart murmur for many years.
• Calcific aortic stenosis occurs in older patients and is due to calcification that occurs as we age.
• Rheumatic fever as a cause is becoming uncommon.

Symptoms

With aortic stenosis, the left ventricle must pump blood against the obstructed valve.  Because of the strain on the ventricle, the muscle becomes thickened, like a weightlifter's muscle.  Over time, there are usually three major symptoms that can develop. 

• Shortness of breath from heart failure.
• Chest pain from inadequate blood supply to the thickened muscle.
• Blacking out spells from inadequate circulation to the brain. 

Diagnosis

Along with the physical examination which reveals a murmur, the electrocardiogram or ECG may show signs of strain on the heart.

• Echocardiogram.  This ultrasound picture of the heart can show the stenotic aortic valve and estimate the pressure across aortic valve.
• Transesophageal echocardiograms can provide even better pictures. 
• Cardiac catheterization can reveal blockages in the heart arteries and can directly measure the pressure across the aortic valve.  The area of opening of the aortic valve can be measured or calculated in a variety of ways.  A normal aortic valve area is greater than or equal to 2.0 cm2.
  • Mild aortic stenosis: Valve area is between 1.5-2.0 cm2 with a pressure gradient of less than 25 mmHg
  • Moderate aortic stenosis: Valve area is 1.0-1.5 cm2 with a gradient of 25-40 mmHg
  • Severe aortic stenosis:  Valve area is less than 1.0 cm2 and with a pressure gradient of greater than 40 mmHg
  • Extremely severe: Valve area is less than 0.6 cm2 and the pressure gradient is more than 60 mmHg.  
• Stress testing can be used to determine if an asymptomatic patient will develop symptoms with significant exercise.

Medical Treatment

Patients can go many years without having any symptoms from aortic stenosis, but once symptoms develop, the chance of dying increases substantially.  Death can occur suddenly and without warning in some cases.  In addition, there really are no medicines that can treat this mechanical valve problem.  Observation is indicated generally only for patients with no symptoms, and they must be followed carefully.

Surgical Treatment

• Indications: Surgery is indicated in almost all patients with symptoms from aortic stenosis.
• Early Surgery: There are some circumstances where surgery can be considered in a patient with no symptoms:
  • Asymptomatic patients with normal activity but who develop symptoms with exercise testing.  These patients are not truly "asymptomatic". 
  • Patients with signs of deteriorating heart function.  Normally, the heart can pump out around 50-60% of the blood within it.  This is called the ejection fraction.  When the heart deteriorates, the pumping ability decreases and the ejection fraction falls.  If the ejection fraction in a patient with aortic stenosis falls below 50%, this may be a time to consider surgery. 
  • Patients with severe aortic stenosis if the valve appears to be rapidly calcifying on serial examinations.
  • Patients with extremely severe stenosis and the risk of surgery for that patient is considered to be low. 

Back to top