Aortic Valve Disease

Overview

Aortic valve disease refers to any condition that affects the valve between the heart's main pumping chamber, the left ventricle, and the aorta — the large artery that carries blood to the rest of the body. The aortic valve normally has three leaflets and opens and closes with each heartbeat, keeping blood flowing in one direction. When the valve cannot open fully or does not close properly, the heart must work harder and serious problems can develop over time.

Aortic valve disease can follow a slow, silent course for many years. Symptoms often do not appear until the disease has reached an advanced stage. As the heart struggles to compensate for a malfunctioning valve, shortness of breath, fatigue, chest pain, and fainting can develop. Early diagnosis and regular monitoring make a meaningful difference in how the disease progresses.

Aortic valve disease includes several distinct conditions. Each has its own pattern of symptoms, underlying causes, and treatment approach.

Types

• Aortic valve stenosis. The valve leaflets gradually thicken and calcify, stiffening over time. Because the valve cannot open fully, blood flow out of the heart is restricted and the left ventricle must work increasingly hard with each beat. It is one of the most common serious valve conditions and develops most often from calcification in older adults. In people with a bicuspid aortic valve, significant narrowing can occur at a much younger age.
• Aortic valve regurgitation. The valve does not close completely and a portion of the blood pumped into the aorta leaks back into the left ventricle. The heart must pump this extra volume with every beat, gradually becoming overloaded and enlarged. Rheumatic fever, a bicuspid aortic valve, dilation of the aorta, and infections are among the most common underlying causes.
• Bicuspid aortic valve. This is a congenital condition in which the aortic valve develops with two leaflets instead of the normal three. It is one of the most common heart abnormalities present from birth. A bicuspid valve predisposes both to stenosis and regurgitation. It is also frequently associated with dilation of the aorta — meaning the large artery gradually stretches wider than it should — which requires monitoring in its own right. Lifelong follow-up is necessary.

Symptoms

Aortic valve disease may produce no symptoms for a prolonged period. As the disease progresses and the heart can no longer fully compensate, symptoms begin to emerge.

• Shortness of breath. Initially this may occur only during physical exertion. Over time it can also develop at rest or when lying flat.
• Fatigue and weakness. When the heart cannot pump efficiently, a persistent sense of exhaustion may develop.
• Chest pain or pressure. This is particularly associated with aortic stenosis and is typically brought on by exertion.
• Dizziness or fainting. In significant aortic stenosis, dizziness or loss of consciousness during or after exercise can occur. This should always be taken seriously.
• Palpitations. The heart may feel as though it is racing, pounding, or beating irregularly.
• Swelling in the legs and ankles. As the disease advances, fluid can accumulate in the body.

When to Seek Medical Care

See a doctor if you notice any of the following.

• Shortness of breath during activity or at rest
• A noticeable and unexplained decline in exercise capacity
• Palpitations or a sensation of irregular heartbeat
• Unexplained fatigue or swelling in the legs

Call emergency services immediately if you experience any of the following.

• Sudden, severe chest or back pain
• Fainting during or after exercise
• Sudden, severe shortness of breath

Causes

The cause of aortic valve disease depends on the specific type.

• Age-related calcification. Progressive calcium buildup on the valve leaflets causes them to stiffen and narrow. This is the most common cause. High blood pressure, high cholesterol, and diabetes can accelerate the process.
• Bicuspid aortic valve. This congenital abnormality predisposes to both stenosis and regurgitation, and valve disease in these individuals tends to develop at a considerably younger age.
• Rheumatic heart disease. Untreated streptococcal throat infections can trigger rheumatic fever, which leaves permanent scarring on the valve leaflets.
• Infective endocarditis. Bacterial infection of the valve leaflets can cause rapid and serious valve damage.
• Dilation of the aorta. When the large artery just beyond the heart stretches wider than normal, the ring supporting the valve can widen too, preventing the leaflets from closing fully. This is associated with Marfan syndrome, a bicuspid aortic valve, and high blood pressure.

Diagnosis

Aortic valve disease is often first suspected when an abnormal heart sound, or murmur, is heard during a routine examination, or when imaging done for another reason reveals a valve abnormality. The main tests used include the following.

• Echocardiogram (heart ultrasound). The cornerstone of diagnosis. It shows the structure and motion of the valve leaflets, quantifies the degree of narrowing or leaking, and assesses the size and function of the left ventricle. Dilation of the aorta can also be measured with this test.
• Electrocardiogram (ECG). Records the heart's electrical activity and can identify rhythm disturbances or changes related to heart enlargement.
• Aortic imaging. When aortic dilation is present, computed tomography or magnetic resonance imaging is used to visualize the full length of the aorta in detail.
• Coronary evaluation. Before any surgical or catheter-based procedure, the heart's arteries are assessed to identify any additional disease that may need to be addressed at the same time.

Treatment

Treatment is determined by the specific type of aortic valve disease, its severity, and the patient's overall health.

• Monitoring. In mild to moderate disease without symptoms, regular echocardiography and clinical review are sufficient.
• Medications. Drugs cannot repair the valve itself, but they relieve symptoms, protect the heart, and help prevent complications. Blood pressure control, heart failure medications, and management of rhythm disturbances all play a role.
• Surgical valve repair or replacement. When the disease advances sufficiently, the valve may need to be repaired or replaced. Both biological and mechanical valve options are available, and the choice is made in discussion with the cardiologist and surgeon based on the patient's age, circumstances, and preferences.
• Catheter-based procedures. Minimally invasive options that do not require open heart surgery are increasingly available. For aortic stenosis, transcatheter aortic valve implantation (TAVI) — in which a new valve is delivered through a catheter passed through a blood vessel — is an option for suitable patients who face a higher surgical risk or prefer a less invasive approach.

Lifestyle and Follow-up

Aortic valve disease requires ongoing monitoring throughout life. Managing modifiable risk factors such as high blood pressure, high cholesterol, and diabetes can slow disease progression. Stopping smoking has a direct and meaningful benefit for heart and vascular health.

Some patients with aortic valve disease are advised to take antibiotics before dental procedures and certain surgeries to reduce the risk of valve infection. Always inform your dentist and any treating doctor about your valve condition.

Echocardiography is used at regular intervals to assess valve function and the size of the heart's chambers. The frequency of follow-up is determined by the severity of the disease. Do not wait for a scheduled appointment if new symptoms develop — contact your doctor promptly.