What You Need to Know About Aortic Valve Disease
Teng C. Lee, MD
According to data from the Alliance for Aging Research, as many as
5.8 million Americans have aortic valve disease – making it an incredibly common form
of heart disease, particularly among older adults.
So, what, exactly, is aortic valve disease?
Your heart is made up of four chambers – two atria and two ventricles.
Oxygenated blood passes from the left ventricle into the aorta, your main
artery, before circulating to the rest of your body. When your heart squeezes,
the aortic valve opens to allow blood to pass through to the aorta. When
it relaxes, that valve closes to prevent blood from flowing from the aorta
back into the heart.
As you’ve probably guessed, Aortic Valve Disease happens when this
structure isn’t functioning properly. It’s called aortic regurgitation
when the valve doesn’t close all the way and blood leaks back into
the heart. Or when the valve doesn’t fully open which reduces blood
flow, it’s called aortic stenosis. Because both of these are mechanical
issues of the aortic valve – meaning something isn’t working
quite right – they may be managed to a certain extent with medication,
but can only be treated using surgical methods.
How Does it Affect My Body?
When your aortic valve isn’t functioning properly, your heart has
to work even harder to pump blood through your heart. Over time, this
increased effort can result in enlargement of the heart, which actually
reduces its ability to effectively and efficiently circulate blood.
When left untreated, some common complications caused by this condition include:
- Heart failure
- Arrhythmia (abnormal heart rhythm)
Am I at Risk for Aortic Valve Disease?
While some aortic valve defects may be congenital, it can also be caused
by infection, injury, or, most commonly, the aging process. In fact, as many as
1 in 8 people over the age of 75 show signs of moderate-to-severe aortic stenosis.
Aortic valve disease risk factors include:
- Being over the age of 60
- Heart conditions present at birth, like bicuspid aortic valve disease
- A history of infections of the heart, including rheumatic fever and endocarditis
- Injury or damage to the aortic valve
- Hypertension (high blood pressure)
When Should I See a Doctor?
Because the complications associated with aortic valve disease increase
in severity the longer this condition is left untreated, it’s important
to see your primary care provider if you’re experiencing any of
the following symptoms:
- Chest pain or tightness
- Feeling lightheaded or passing out
- Shortness of breath
- Increased fatigue after being active
- Abnormal heartbeat
- Swelling of the feet and ankles
Your doctor will typically listen for an abnormal heart murmur (the sound
of blood passing through your valves) using a stethoscope, then refer
you to a cardiologist for a definitive diagnosis.
What Are My Treatment Options?
Aortic valve disease is an issue with your heart mechanics that, while
it can be managed with medication and lifestyle modification, requires
surgical intervention to definitively fix. While open aortic valve replacement
or repair surgeries have long been the gold standard in treatment, transcatheter
aortic valve replacement (TAVR) procedure is a promising recent development.
Open aortic valve surgery is an open-heart surgery. Although it comes with
certain risks, such as bleeding, arrhythmia, infection, stroke and death,
and has a longer recovery time, it’s still the most common form
of treatment with the best long-term outcomes. In fact, it’s a procedure
that we regularly do here at Washington Hospital.
In comparison, transcatheter aortic valve replacement is a minimally invasive
procedure in which a catheter is inserted into an artery via a small incision
in the chest or groin. The catheter carries a collapsible valve through
the artery to the valve site; once expanded, the new valve pushes the
malfunctioning valve leaflets apart and takes over. Because it doesn’t
cause as much bodily trauma as open-heart surgery, patients usually feel
noticeably better upon waking and are able to leave the hospital within
However, because the TAVR procedure has only been commercially available
in the United States since 2011, there’s not a lot of data on its
long-term durability. There’s some data suggesting that the need
for a pacemaker is more common after TAVR than after open aortic valve
replacement. Washington Hospital is currently developing a TAVR program,
but through the affiliation with UCSF Health, TAVR is now offered by my
colleagues and me at UCSF.
The decision on valve repair or replacement, as well as which therapy is
right for you depends on a number of factors including the severity of
your condition, your age and general health, and whether you require surgical
intervention to treat related conditions (aortic valve disease is sometimes
found alongside coronary artery disease, which requires bypass surgery).
While the idea of surgery may sound scary, not treating your aortic valve
disease is deadly. A skilled team, like the one we have here at Washington
Hospital, can effectively treat your condition through surgical intervention,
so you can live a longer, healthier and higher-quality life. To learn
more about Washington Hospital’s Heart and Vascular Program, visit the
Washington Hospital website.
Posted February, 2019
About Teng C. Lee, MD
Teng C. Lee, MD, FACS, joined UCSF as an Associate Professor of Surgery
in the Division of Adult Cardiothoracic Surgery. He was previously the
Co-Director of the Aorta Center at University of Florida. Prior to that,
he founded the Center for Aortic Disease at University of Maryland and
also started the highly successful Transcatheter Aortic Valve (TAVR) program
there. Originally from Singapore, he graduated from Washington University
School of Medicine in Saint Louis. He then went on to a general surgery
residency at Case Western Reserve University in Cleveland where he was
also the Dudley P. Allen Scholar before finishing his cardiothoracic surgery
residency at Duke University. He also completed a fellowship in Endovascular/Interventional
Radiology at Skåne University Hospital (Lund University) in Malmö,
Sweden where he trained under the world-renowned Krassi Ivancev, M.D.,
Ph.D. and another fellowship in advanced aortic surgery, heart transplantation,
and mechanical circulatory support at Duke University. Dr. Lee is one
of only a handful of "hybrid" specialists fully cross-trained
in both interventional and open surgical techniques for the treatment
of complex thoracic aortic disease.