Aortic Valve Surgery is performed by cardiac surgeons to treat bicuspid valves, Congenital Aortic Valve Diseases, Aortic Valve Stenosis, and Aortic Valve Insufficiency.
Below are some information that will help you understand the conditions that can affect the aortic valve and why surgical intervention may be necessary to treat your condition.
What is the aortic valve?
Your heart has four valves, including the mitral, tricuspid, aortic, and pulmonary valves.
There are four chambers in your heart, including the left ventricle, right ventricle, left atrium, and right atrium.
The aortic valve is located between the left ventricle (which pumps blood to the whole body) and the aorta, which is the largest artery in the body. The valves ensure one-way blood flow in the heart.
What is Aortic Valve Disease?
In Aortic Valve Disease, the aortic valve does not function properly, and some possible causes are:
Aortic stenosis: This refers to a narrowing of the aortic valve due to stiff, fused, thickened, and inflexible leaflets, which limits blood flow. Aortic stenosis progresses as calcium deposits build up on the leaflets, causing them to lose their mobility. Stenosis can occur in patients with tricuspid (3 leaflets) or bicuspid (2 leaflets) aortic valves.
Aortic valve insufficiency (also known as “leaky valve”): In this condition, the valve does not completely close, resulting in regurgitation (leakage).
What causes Aortic Valve Disease?
The aortic valve can be abnormal from birth (usually bicuspid aortic valve), or the disease can develop over time in older patients (acquired valve disease).
Congenital Aortic Valve Disease
Approximately one to two percent of the population has a bicuspid aortic valve from birth.
In individuals with a bicuspid aortic valve, there are two leaflets instead of the usual three. Without the third leaflet, the valve may not fully close and can cause leakage (regurgitation) or may not fully open, leading to narrowing (stenosis).
In most cases, bicuspid aortic valves can function normally for several years without requiring treatment.
In approximately 25 percent of patients with a bicuspid aortic valve, the aorta can enlarge to some extent. If it becomes significantly enlarged, it is called an Aortic Aneurysm.
Acquired Aortic Valve Disease
In acquired aortic valve diseases, the structure of the valve has changed due to the following reasons:
Infective endocarditis: This occurs when bacteria enter the bloodstream from a distant infection site and adhere to the surface of the heart valves, infecting them. Even small infections like dental cleanings or dental abscesses can cause serious bacterial endocarditis in the aortic valves.
Rheumatic fever: generally caused by a bacterial throat infection such as streptococcus. In rheumatic fever, the valve itself is not infected with bacteria, but the antibodies produced by the body to fight the infection react with the heart valves, causing the fusion and hardening of the aortic valves.
Aortic valve degeneration from wear and tear: is another cause of acquired aortic valve disease. In many patients, the aortic valves degenerate and calcify over time. This most commonly leads to aortic stenosis, but it can also cause aortic regurgitation. It is the most common cause of aortic stenosis in individuals over the age of 65.
Other causes of aortic valve disease include rheumatoid arthritis, chronic inflammatory diseases, lupus, syphilis, hypertension, aortic aneurysms, connective tissue disorders, and less commonly, tumors and certain types of medications and radiation used for cancer and lymphoma.
What are the symptoms of aortic valve disease?
Many patients with aortic valve disease are asymptomatic (have no symptoms) even if they have severe stenosis or regurgitation.
The initial symptoms of aortic valve disease typically include:
- Fatigue
- Easy tiredness
- Loss of energy
- Swelling of the ankles
- Palpitations (extra or skipped heartbeats)
More advanced symptoms may include:
- Shortness of breath
- Chest pain
- Dizziness or fainting
How is aortic valve disease diagnosed?
Your doctor will diagnose aortic valve disease by reviewing your symptoms, performing a physical examination, and evaluating the results of diagnostic tests.
During the physical examination, your doctor will listen for the sound of turbulent blood flow through the abnormal valve using a stethoscope, known as a heart murmur.
The diagnosis of aortic valve disease is confirmed with a specialized heart ultrasound called an echocardiogram. An echocardiogram allows your doctor to visualize the heart valves on a screen and determine the severity and possible cause of the aortic valve disease.
In most cases, a standard transthoracic echocardiogram (a non-invasive procedure where an ultrasound probe is moved over the chest with gel) is sufficient.
Sometimes, a transesophageal echocardiogram (TEE – a probe passed through the mouth into the esophagus) is necessary to get a closer look at the valve. TEE is performed as an outpatient procedure.
