About aortic valve disease
The aortic valve is the valve connecting the main pumping chamber of the heart (left ventricle) and the main artery (aorta).
There are two types of aortic valve disease:
- Aortic valve stenosis – when the aortic valve opening is narrowed, preventing the valve from opening and closing properly. This obstructs blood flow from the heart into the aorta and the rest of the body.
- Aortic valve regurgitation – when the aortic valve doesn’t close properly, causing blood to flow backwards into the heart.
Aortic valve stenosis can be caused by calcification and fibrosis of the valve leaflets (formation of chalky material with calcium). Around 2% of the population are born with a form of aortic valve which has two cusps (bicuspid aortic valve) as opposed to the usual three. The patients with bicuspid aortic valve are more prone to both narrowing and leakage of the valve.
Any or combinations of symptoms including shortness of breath, chest pain and tiredness can be present. However, some patients may have no symptoms and a heart murmur is diagnosed during routine check-up.
Diagnosis and tests
- Echocardiography is an ultrasound scan which evaluates the heart valves, aorta and the ventricles (the pumping chambers of the heart)
- CT / MRI may be required to evaluate the aorta and its base (aortic root)
- Coronary Angiography is a test to evaluate the state of the coronary arteries (vessels running on the surface of the heart). It is performed by injecting a dye into the groin or an arm vessel and then imaging the coronary arteries.
Treatment for aortic valve disease
The operation is performed through an incision down the middle of the chest or a smaller ‘mini’ incision, depending on the type of surgery. The valve is replaced with an artificial heart valve, either a mechanical or a tissue valve:
- The mechanical valve has a very long life, does not really wear and tear, but the patient needs to take a drug called warfarin which thins the blood and prevents blood clot formation on the mechanical valve. Warfarin needs to be taken indefinitely.
- Tissue valves are made of animal tissue, have a limited life, but the patient does not need to take warfarin.
Transcatheter aortic valve implantation (TAVI)
TAVI is an option for valve replacement for patients who are not thought to be fit for surgery as it is less invasive and requires shorter hospital stay. The long-term durability of TAVI in younger patients is uncertain.