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What is aortic valve stenosis?

The aortic valve connects the heart’s main pumping chamber (left ventricle) and the aorta, which carries oxygenated blood to the brain and the rest of the body. Aortic stenosis is a structural heart disease: a defect or abnormality in the heart's valves or vessels. Aortic stenosis is a buildup of calcium deposits on the valve, which obstructs blood flow because the narrowing of the valve prevents it from opening properly. The left ventricle then has to work harder to pump blood and its muscles thicken, which causes chest pain. Blood may even back up into the lungs. Severe aortic stenosis can be either congenital (existing before birth or at birth) or acquired (developing over the course of your life), and can cause life-threatening impairment of heart function. Many patients with aortic stenosis also have a heart murmur.

Most cases of aortic stenosis consist of calcific (degenerative) aortic stenosis or congenital bicuspid aortic stenosis. Less common forms of the disease are rheumatic aortic stenosis, radiation-induced aortic stenosis and unicuspid aortic stenosis.

Our approach

Northwell Health is a leader in the treatment of aortic valve disease, offering patients advanced procedures that may not be available at other health systems. The expert multidisciplinary team of cardiologists and interventionalists, cardiovascular surgeons and anesthesiologists, echocardiographers, physician assistants, nurses, operating room staff and other healthcare professionals in our pioneering Adult Congenital Heart Disease Program provides the most advanced ongoing care for adult congenital heart defects. Cardiac surgery services within Northwell Health offer the latest diagnostic procedures and the most progressive noninvasive and traditional treatments. Our patients are cared for in our state-of-the-art facilities, including hybrid operating rooms combining the imaging capabilities of a traditional cardiac catheterization laboratory with the functionality of a cardiac operating room. 

Symptoms

Symptoms of this heart defect vary, with severe forms in the newborn such as poor cardiac output and bluish discoloration of the skin caused by lack of oxygen in the blood. Other infant symptoms may include lethargy, poor feeding, increased respiratory effort or poor weight gain.

Adult symptoms most often include:

  • Chest discomfort: tightness or squeezing that may worsen with activity and reach into the arm, neck or jaw
  • Cough, possibly bloody
  • Breathing problems when exercising
  • Fatigue
  • Palpitations (feeling the heart beat)
  • Fainting, weakness or dizziness with activity

Mild to moderate symptoms of aortic stenosis may not require any treatment other than routine monitoring by a healthcare provider. Sometimes the condition is not detected until a physician’s examination reveals a heart murmur, by which time the disease may be advanced.

When to see a doctor

Anyone experiencing angina (chest pain) or the symptoms listed above should immediately see a physician. The doctor should give you a thorough physical examination and take your detailed medical history, including asking about your level of activity and any changes in your ability to carry out your usual exercise routine.

Causes

Aortic valve stenosis can have several causes:

  • Having abnormal aortic or bicuspid valves at birth
  • Having chest radiation such as for cancer treatment (a rare occurrence)
  • Rheumatic fever, which sometimes follows strep throat or scarlet fever (also rare)

Risk factors

Aortic stenosis poses different risks to men, women and children, as well as those with other medical conditions:

  • Men are more at risk for aortic stenosis than women.
  • Children are at risk for bacterial endocarditis (heart infection).
  • Patients with severe aortic stenosis are generally older, with multiple medical conditions that can put them at very high risk if traditional surgical procedures are performed.

Diagnosis

An echocardiogram can evaluate for aortic valve stenosis, making diagnostic catheterization rarely necessary. However, to determine whether coronary artery disease is present in patients who will undergo valve surgery, preoperative coronary angiography is performed.

Treatments

Northwell Health offers options for transcatheter aortic valve replacement replacement (TAVR): cutting-edge alternatives to open heart surgery that have excellent success rates.

For patients who require aortic valve replacements and are considered good candidates, minimally invasive techniques are available, including either a partial sternotomy or a minimally invasive incision between the ribs, to avoid splitting of the breastbone. Patients with mitral valve disease may have an option for a less invasive operation, performed through a 3-inch incision between the ribs on the right side of the chest. The benefits of minimally invasive valve surgery include shorter recovery times, fewer complications and less scarring. The following treatments are available for aortic valve stenosis:

  • Interventional catheterization/balloon valvuloplasty – This is the most common procedure used to treat aortic stenosis. A catheter is inserted into a blood vessel in the groin, brought through the aorta into the heart and placed into the diseased valve. A balloon at the tip of the catheter inflates until the valve flaps (leaflets) open. The balloon is then deflated and the catheter removed.
     
  • Transcatheter aortic valve replacement surgery (TAVR) – Previously, older patients with multiple medical conditions had few or no treatment options, because traditional cardiac surgery involves an incision along the sternum (sternotomy) to access the heart. High-risk patients with severe aortic stenosis can now be considered for TAVR, a less invasive procedure that replaces a diseased aortic heart valve percutaneously — meaning through the skin — without a sternotomy and without surgical removal of the diseased valve.

    During the procedure, the cardiac surgeon inserts a replacement aortic valve (either a mechanical or donor valve) near the patient's own aortic valve through a small puncture in the femoral artery of the leg or through a small incision in the side of the chest. Employing a technique similar to that used to implant cardiac stents into clogged arteries, the physician guides a catheter to the heart, with the artificial valve attached. Transesophageal echocardiogram (TEE) and fluoroscopic imaging check the valve for proper placement. The valve expands, is anchored inside the aorta and blood flow is restored.
     
  • Robotic heart surgery – The Minimally Invasive and Robotic Heart Valve Surgery Center at Northwell Health is the first center on Long Island to use the Da Vinci® surgical robotic system to perform minimally invasive heart operations. Through a console in the operating room, the surgeon’s hand motions control the robotic arm, which inserts miniature instruments between the patient’s ribs rather than splitting any bones. This technology has enabled many cardiac procedures to be performed less invasively, without sternotomy.

In terms of nonsurgical treatments, medication can be helpful in managing specific symptoms of heart failure and abnormal heart rhythms (atrial fibrillation) but is not a cure for aortic valve stenosis.