Aortic stenosis (AS) is a disorder in which the opening of the aortic valve in the heart is too small or stiff. A valve is like a doorway, and the aortic valve is one of four valves controlling blood flow inside the heart. A normal aortic valve has three flaps (leaflets). The heart sends oxygen rich blood to the body through this valve. In AS, the heart works harder to pump blood through the smaller opening. This extra effort can make the heart grow big and weak.
AS occurs about three times more often in men than in women.
Calcium and cholesterol deposits on the valve that occur with aging are the most common cause. Some people are born with damaged valves or have a two-sided (bicuspid), not three-sided, valve. Heart disease or rheumatic fever from childhood infections may also damage the valve.
Most people at first have no symptoms. If the valve narrows enough, feeling tired, fainting with exercise, having chest pain with exercise or at rest, or having symptoms of left-sided heart failure (e.g., shortness of breath) may occur. Breathing problems during exercise may progress to problems at rest, or waking up at night unable to breathe.
The health care provider will take a medical history and do a physical examination. The health care provider may hear a heart murmur (an extra or unusual sound of blood flow through the valve during the heartbeat). If AS is suspected, the health care provider will order echocardiography (using sound waves to take heart pictures) to diagnose AS.
Additional tests such as heart catheterization (using x-rays and dye) may be done before surgery to replace the valve in order to estimate how severe the aortic stenosis is.
People without symptoms and with mild stenosis may not need treatment but should be monitored on a periodic basis by their health care provider. For people with symptoms or severe disease, surgery to replace the valve is best.
Sometimes, a special balloon is put in the valve and blown up so the valve stretches (valvuloplasty). Valvuloplasty is often used in younger people who will get a replacement valve after they grow and in severely ill patients who are not surgical candidates. A newer procedure called transcatheter aortic valve replacement (TAVR) allows replacement of the aortic valve through the good vessels instead of open heart surgery for patients who are too ill for open heart surgery.
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