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Heart Health

What You Need to Know About Aortic Valve Disease

Author: Teng C. Lee, MD
Cardiothoracic Surgery

person holding stuffed heart

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)
  • Death

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 three days.

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.