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Aortic Valve Stenosis

The aorta is the largest artery in the body. Its role is to carry blood from the heart to the rest of the body.

The aortic valve opens and closes to help control this one-way flow from the heart into the aorta. Aortic stenosis (AS) means your aortic valve doesn't open wide enough to allow enough blood flow from your heart to your aorta.

The UPMC Heart and Vascular Institute offers full-range AS treatments, including surgery and minimally invasive valve replacement. In fact, we were among the first in the U.S. to perform minimally invasive transcatheter aortic valve replacement.

Contact the UPMC Heart and Vascular Institute

To request an appointment, contact the UPMC Heart and Vascular Institute:


What Is Aortic Stenosis (AS)?

Your heart has four valves that work to keep blood flowing in the right direction.

Think of your aortic valve as “the exit door" of your heart. It's where your heart meets your body's largest artery — the aorta.

Your aortic valve has three parts, called flaps or leaflets, which connect to the annulus ring.

In a healthy heart, when the left chamber squeezes, blood flows out of it. The flaps of the aortic valve open to let blood flow through.

When the heart relaxes, the flaps snap shut to prevent blood from flowing backward.

The term stenosis is the narrowing of an internal part of the body.

In AS, the valve doesn't open wide enough and limits blood flow from the heart into the aorta. In response, your heart works harder to pump enough blood to meet your body's needs.

Over time, this can cause your heart to weaken and can lead to heart failure.

At UPMC, we take a team-based approach to tailoring the right aortic valve stenosis treatment to your unique needs.

Aortic stenosis causes

AS is common heart disease. It affects about 5% of people over the age of 70.

Although it's sometimes present at birth, AS is more common in older adults.

As you age, calcium deposits in your aortic valve can cause it to stiffen and not correctly open. This narrowing may lead to heart failure and a range of other issues.

1-2% of people are born with a bicuspid aortic valve — a heart defect that can lead to AS.

Doctors often don't notice it in babies and growing children, and it may not cause problems until adulthood. Over time, the aortic valve may get tight or leaky.

Aortic stenosis risk factors

Factors that increase your risk of AS include:

  • Age. It often occurs in people older than 65 years.
  • Atherosclerosis. A disease of buildup in the artery walls causing them to harden. This condition can go hand in hand with aortic stenosis.
  • Bicuspid aortic valve. A condition in which the aortic valve has two flaps instead of three. This can cause the valve to leak or narrow.
  • Diabetes mellitus. People with diabetes are more likely to get aortic stenosis because it may speed up plaque buildup in the arteries.
  • High cholesterol. Having high cholesterol can cause inflammation and lead to aortic stenosis.
  • Rheumatic fever. An infection that can cause the scarring of the heart's valves.
  • End-stage kidney disease. Aortic stenosis tends to progress more quickly in people with chronic kidney disease.

Aortic valve stenosis complications

AS can lead to problems, such as:

  • Heart failure. Aortic stenosis makes the heart muscle work harder, which weakens it over time, leading to failure. Look for symptoms, including fatigue, shortness of breath, and swelling of the legs, ankles, and feet.
  • Endocarditis. This is a bacterial infection within your heart. People with aortic stenosis have a harder time fighting it.

Aortic stenosis prevention

AS is a progressive condition.

Ways to help prevent it include:

  • Forming heart-healthy habits.
  • Controlling cholesterol and blood pressure.
  • Managing diabetes may help prevent stenosis.

See your UPMC heart doctor regularly. Ongoing follow-up care is vital to check your heart disease for possible progression.

Aortic stenosis is a condition in which your aortic valve does not open widely enough to allow adequate blood flow from your heart to your aorta. 

Learn more from the UPMC HealthBeat blog:

Aortic Stenosis (AS) Symptoms and Diagnosis

The effects of aortic valve stenosis range from mild to severe.

Many people don't notice symptoms of AS or only notice them during physical activity.

AS symptoms

Signs of AS include:

  • Chest pain — or angina — this may feel like a tightness or burning sensation.
  • Lightheadedness, fainting, or shortness of breath with exertion.
  • Heart rhythm problems, heart palpitations, fluttering heart, or rapid heartbeat.
  • Heart murmur.
  • Fatigue.

AS can weaken the heart and lead to heart failure.

It can also cause daily health problems such as:

  • Shortness of breath.
  • Swollen ankles and feet.
  • Chest pain.

When to see a doctor about aortic valve stenosis

You should see a heart doctor to treat your AS if you have:

  • Shortness of breath.
  • Chest tightness.
  • Signs of heart failure.
  • Fainting spells.
» Find a cardiologist at the UPMC Heart and Vascular Institute.

Diagnosing aortic stenosis

Your doctor can detect AS by listening to your heart and hearing abnormal valve sounds called murmurs.

Your UPMC heart doctor may order tests to confirm the diagnosis. These tests may also diagnose other conditions such as heart rhythm problems or atherosclerosis.

Diagnostic tests you may need include:

  • Echocardiogram, which uses sound waves to make images of your heart and valves.
  • EKG, which traces your heart's electrical activity.
  • Chest x-ray, which shows the size and shape of your heart.
  • Heart catheterization, which lets your doctor see blood flow through the vessels that supply blood to the heart.
  • MRI scan, which uses a magnet and radio waves to take pictures of your heart.

Learn more from the UPMC HealthBeat blog:

Aortic Stenosis Treatment

Your heart doctor will design a treatment plan to control AS and any other health problems it may cause.

Medicine

Drugs do not help AS itself, but they do treat other conditions and can help you feel better.

For instance, if you have symptoms of heart failure, your doctor may prescribe medicine to:

  • Prevent the buildup of excess fluids.
  • Increase blood flow in your narrowed blood vessels.
  • Prevent the production of hormones that cause the heart to work harder.

To treat AS directly, your UPMC doctor may suggest valve replacement.

Surgery to replace the aortic valve

Open heart surgery to replace aortic valves has long been the standard treatment for AS.

During surgery, your UPMC surgeon makes an incision in the middle of your chest and divides the breastbone in half.

This gives them access to the heart to remove your aortic valve and replace it with either a:

  • Mechanical valve. This valve lasts a long time, but you'll need to take a life-long blood thinner (warfarin, Coumadin®) to prevent blood clots.
  • Tissue valve. These replacement valves don't last as long as mechanical valves, but you won't need to take blood thinners.

Other options for replacing your aortic valve include:

  • Stentless valves.
  • Ozaki procedure.
  • Ross procedure.

TAVR (transcatheter aortic valve replacement)

TAVR is a minimally invasive approach to replace the aortic valve through a small tube or catheter.

During TAVR, your surgeon:

  • Makes a small incision in the groin and places the tube with the new valve in a blood vessel.
  • Uses a special moving x-ray — called fluoroscopy — to guide the tube to your diseased aortic valve.
  • Places the new valve over your own aortic valve and removes the tube from your groin.

Which aortic valve replacement treatment is right for me?

Experts at the UPMC Center for Heart Valve Disease work together to decide whether surgery or TAVR is best for you. 

Learn more from the UPMC HealthBeat blog:

Aortic Stenosis Educational Materials

The UPMC Heart and Vascular Institute offers educational information and videos about aortic stenosis and other heart and vascular diseases and treatments.

Many people find these resources helpful in answering their questions about their condition and preparing them for their procedure or diagnostic test.

The links below will open a new browser window.

From our Health Library