Aortic valve stenosis

What is aortic valve stenosis?

Aortic valve stenosis (AVS) means that the aortic valve is narrow and cannot open fully. It can also be known as:

• aortic stenosis
• valvular aortic stenosis.

The aortic valve is the valve which allows blood to flow from the lower left chamber of the heart (the left ventricle) to the main artery supplying blood to the rest of the body (called the aorta).

• Learn how a healthy heart looks and works.

Aortic valve stenosis causes your heart to pump harder because it needs to push blood through the narrow aortic valve. Over time, this may cause the heart to get bigger and become weaker.

If not treated, aortic valve stenosis can cause problems with your heart like heart failure.

Types of congenital aortic valve stenosis

There are 3 types of congenital aortic stenosis, you will be diagnosed depending on where the narrowing (or stenosis) is.

Valvular aortic stenosis

This is a type of aortic valve stenosis where the aortic valve is narrowed. It is the most common type of aortic valve stenosis and is usually caused by a bicuspid valve (a valve with 2 flaps instead of 3).

Supravalvular aortic valve stenosis

This is where the aorta is narrowed just after the aortic valve. This can also cause problems with the valve. This type of aortic valve stenosis is usually caused by another genetic condition called William’s syndrome.

Subaortic stenosis

This type of aortic valve stenosis occurs below the aortic valve.

Speak to your doctor if you have any questions about what type of stenosis you have.

Aortic valve stenosis causes

Congenital aortic stenosis at birth is usually caused by a bicuspid aortic valve. A bicuspid aortic valve is an aortic valve that has only 2 flaps (or cusps) to close the valve instead of 3.

In most cases, we do not know why the valves have not developed normally in the womb. Research is looking at the causes of congenital heart disease.

• Read more information on congenital heart disease and causes.

Aortic stenosis symptoms

Symptoms of aortic valve stenosis depend on how severe it is. Symptoms can appear in babies, children and adults.

Mild to moderate aortic valve stenosis usually causes no symptoms except for a heart murmur.

A heart murmur is an extra, unusual sound in your heartbeat that the doctor hears when checking your heart with a stethoscope.

Severe aortic valve stenosis can cause symptoms such as:

• chest pain, especially when exercising
• feeling very tired
• difficulty breathing
• fainting
• heart murmur
• heart palpitations.

Speak to your doctor if you notice any of these symptoms.

Diagnosis of aortic stenosis

Your doctor might suspect aortic valve stenosis if they hear a murmur or click while checking your heart with a stethoscope.

To confirm the diagnosis, they might refer you for the following tests:

• Echocardiogram (or echo). This is an ultrasound of your heart. It shows how well your valves are working.
• Transoesophageal echocardiogram (or TOE). This is another type of echo that shows more details about how your valves are working.
• Exercise testing. This test shows if you get any symptoms when doing exercise and helps doctors to diagnose you.
• MRI or CT scan. In some cases, your doctor might recommend an MRI or CT scan to see your heart more clearly.

Aortic valve stenosis treatment

The best treatment for aortic valve stenosis is surgery. So far medicines have not been shown to work when treating aortic valve stenosis.

The right surgery for you depends on the type of aortic valve stenosis you have and how severe it is.

If you have any questions about what treatment is best for you and your condition, you should speak to your surgeon and doctors.

Balloon valvuloplasty

This is a procedure where the doctor inserts a thin tube (also known as a catheter) into an artery in your leg and guides it to your heart.

The tube has a balloon at the end of it. Once the tube reaches your heart, the balloon is inflated to open up the narrowed valve. The balloon is then deflated and the tube is removed.

Valve replacement

Your valve might need to be replaced if a balloon valvuloplasty is not suitable for you. Valve replacement is an open-heart procedure meaning the surgeon will work directly on your heart.

Your aortic valve may be replaced by a mechanical valve or a biological valve.

A mechanical valve will last longer but you need to take anticoagulant medicines for the rest of your life to prevent blood from clumping up around the valve.

The Ross procedure

This procedure involves replacing the aortic valve with your own pulmonary valve (the valve that controls blood flow from your heart’s right ventricle to your lungs).

Your pulmonary valve will be replaced with a donor valve from another person.

• Learn more about heart valve surgery including the benefits, types, preparation and recovery.

Life with aortic valve stenosis

If you have mild or moderate aortic valve stenosis, you should be able to live a healthy normal life. You will still need to see your doctor to make sure your heart is working and not getting worse.

Your doctor will let you know how often they need to see you. It is very important to go to follow-up appointments, even if you feel well.

You may be prescribed medicines to help look after your heart, it's important to keep taking medicines even if you are feeling well. If you're worried about anything to do with your medicines, speak to your doctor.

Exercise

You should speak to your doctor before starting or making any changes to your exercise routine no matter what your level of aortic valve stenosis is.

You may be able to exercise normally, but it depends on how severe your aortic valve stenosis is, and if you've had it repaired.

Pregnancy

It’s important to speak to your doctor about getting pregnant as they know your individual heart condition and medical information. They can explain any risks and give you more information.

If you become pregnant unexpectedly, speak to your doctor as soon as possible. They can discuss your condition and options with you.

Endocarditis

This is a rare infection that causes inflammation of the valves and inner lining of the heart. People with congenital heart diseases, including aortic valve stenosis, and people who have had heart valve replacements have an increased risk of endocarditis.

To reduce the risk of developing endocarditis, your doctor might recommend antibiotics after surgery.

In some cases, you may need to take antibiotics before you have dental work to reduce your risk of endocarditis. Check with your doctor and dentist to see if this applies to you.

More useful information and support

Your healthcare team are here to support you. You can ask them anything. It might feel uncomfortable or embarrassing to ask questions but most people feel much better once they do.

Here are some other ways you can get support.

• Read about the most commonly asked questions about congenital heart diseases. We talk about things like alcohol, mental health, preparing for surgery, and more.

• If you still have more questions, speak to our cardiac nurses on our Heart Helpline by phone, callback, email or online chat (Monday to Friday, 9am to 5pm).

• You can also speak to others with heart conditions by joining a support group or online community.