Aortic Valve Disease - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

The aortic valve is present in between the left chamber of the heart and the aorta. The aorta pumps blood to all the parts of the body. Any trauma or disease to the valves of the aorta affects blood circulation. It increases the stress on the left chamber of the heart and leads to various complications like heart failure.

What Is the Function of the Aorta?

The aorta is the largest artery that pumps blood from the heart's left chamber (ventricle) to all body parts. The aorta consists of three flaps (cusps) that open and close during blood circulation.

What Is Aortic Valve Disease?

Damage to the valves of the aorta does not allow it to work correctly, leading to a backward flow of blood into the left ventricle.

Types of Aortic Valve Disease:

• Aortic Valve Stenosis: Tissue flaps on each heart valve open and close one time per heartbeat. The flaps are also known as cusps. The aortic valve flaps can occasionally join together or thicken and stiffen, resulting in a narrowing of the valve opening. The narrowed valve decreases or blocks blood flow from the heart to the body's other organs.

• Aortic Valve Regurgitation: This occurs due to improper closure of the cusps of the aortic valve. It is also referred to as aortic insufficiency.

What Causes Aortic Valve Disease?

Several factors cause the disease of the aortic valve.

It comprises:

• By-birth aortic valve defects, wherein only two flaps (cusps) are present rather than three. It is referred to as the bicuspid aortic valve. These valves can function adequately for a few years, and later, any narrowing or thickening can lead to impaired functioning.

• Deposition of calcium in the valves that occurs in association with an increase in age causes narrowing and stiffening of the valves.

• Rheumatic fever induced by bacterial infection of the throat can lead to rheumatic heart disease.

• Increased blood pressure (hypertension) levels also cause aortic valve disease.

• A previous history of any heart disease can predispose to valve defects.

• Infections in any other organ can spread through blood and lead to inflammation of the heart valves and chambers (endocarditis).

• Other conditions like Marfan syndrome (connective tissue disorder) and inflammation of joints in the spine can rarely cause valve diseases.

• History of chest radiation therapy. Radiation therapy is used to treat some cancers. It can take years following radiation therapy for heart valve disease symptoms to become apparent.

What Is the Pathophysiology of Aortic Valve Disease?

Aortic stenosis causes the valve to narrow because of calcifications or leaflet fusion, which reduces the valve's mobility and obstructs the orifice. Progressive endothelial damage, which can initially result in inflammation and an invasion of macrophages and other inflammatory cells, is the cause of calcified aortic stenosis. Similar to the formation of bones, the inflammation and damage cause profibrotic factors to arise and create a collagen matrix that subsequently calcifies.

The size of a healthy aortic valve is 1 to 1.5 inches; symptoms usually do not appear until the valve area is less than 0.3 inches. Maintaining an appropriate cardiac output becomes more challenging depending on how deeply stenotic the valve becomes. The left ventricle experiences remodeling and hypertrophy, which can raise the left ventricular oxygen demand. Combined with a lower cardiac output, this can cause arrhythmias and ischemia (decreased blood and oxygen supply).

What Are the Symptoms of Aortic Valve Disease?

The symptoms can occur suddenly or can develop gradually for years, and they are as follows:

• Difficulty in breathing or shortness of breath.

• Chest pain.

• Rapid heartbeat.

• Abnormal heart sounds (murmurs).

• Coughing

• Fatigue.

• Fainting or dizziness are also observed.

• Swelling in the ankles and legs.

• In children, improper gaining of weight and loss of appetite were also found.

What Are the Possible Risk Factors?

An increased risk of aortic valve disease exists if individuals:

• Are older than 60.

• Possess aortic valve sclerosis, which is characterized by the valve's thickening and calcification but not yet narrowing of the opening.

• Possess a congenital cardiac valve abnormality, such as a bicuspid aortic valve.

• Possess a history of rheumatic fever.

• Possess an endocarditis history.

• Possess several underlying illnesses, such as lupus and Marfan syndrome.

What Are the Different Stages of Aortic Valve Disease?

Aortic valve disease worsens gradually over time. These phases are used by medical professionals to indicate how serious the issue is:

• Stage A (At Risk) - Although individuals do not exhibit any symptoms of aortic valve disease, they do have a minimum of one risk factor for the condition.

• Stage B (Progressive) - This aortic valve disease is mild to moderate. The valve function has changed somewhat, but individuals are asymptomatic.

• Stage C (Asymptomatic, Severe) - This aortic valve disease is quite severe. Individuals are symptom-free when going about their daily business. Nevertheless, during an exercise stress test, they might experience some symptoms.

• Stage D (Severe Symptoms) - Individuals experience symptoms of severe aortic valve disease in their day-to-day activities. In the beginning, they might experience symptoms only when they move. However, they might experience symptoms while at rest later on.

What Are the Tests Done to Determine Aortic Valve Disease?

The various methods involved in the diagnosis of aortic valve disease are:

• A physical examination of the patient and detailed medical and family history is necessary. Heart murmurs are heard through a stethoscope, and patients may present with cough, chest pain, and fatigue during the clinical examination. The other signs detected during the assessment of patients with aortic regurgitation are pounding pulses, alternate blushing, blanching of smaller vessels in the nail bed, bobbing of the head simultaneously with the heartbeat, etc.

• Electrocardiogram (ECG) measures the heartbeat rate and the heart's activity.

• Chest X-ray is done to detect heart enlargement, inflammation, and calcium deposits in the aorta.

• Computerized tomography (CT) scan of the heart produces a precise image of the arteries and detects any deposits.

• Coronary angiography is a procedure done along with cardiac catheterization to view the X-ray images of the heart's arteries. A thin catheter is inserted through the blood vessel of the leg or arm. Special contrast dye is injected into the catheter that moves into the heart's arteries. It helps visualize the blood flow and identify any blockage in the arteries.

• Exercise electrocardiogram test is done to record the heart’s response to physical exercises (treadmill).

• Transesophageal echocardiogram (TEE) is another type of echocardiogram. It involves the insertion of a tiny probe into the throat, which passes down to the stomach. It provides a clear image of the heart vessels and chambers.

How to Treat Aortic Valve Disease?

Medicinal Management:

• Angiotensin receptor blockers and angiotensin-converting-enzyme inhibitors are suggested to decrease high blood pressure.

• Drugs to control cholesterol levels are also suggested.

• Antibiotics are prescribed to treat any bacterial infections.

• Routine physical examination and patient monitoring are crucial in preventing valve disease progression.

Surgical Management:

• Transcatheter aortic valve replacement (TAVR) is a surgical procedure of inserting a new valve through a catheter inside the diseased valve. It is used in case of a severe narrowing of the aortic valves. It is mainly preferred, as smaller incisions are made. The patient recovers fast after the surgery.

• Open aortic valve surgery involves replacing or repairing the diseased and defective aortic valves. It is replaced with mechanical (made of metal) or tissue (animal or human) valves. In this procedure, large incisions are made by the surgeon to visualize the heart directly, and the patient's recovery is slow.

• Ross procedure is primarily preferred in younger patients, and it replaces the diseased aortic valve with another heart valve (pulmonary valve). Then, it is replaced with any other tissue valve, which tends to grow in children in later years.

• Balloon valvuloplasty is another procedure done chiefly on children and younger patients. It increases the opening of the valve and improves the blood flow. A catheter with a balloon on the tip is inserted in the narrowed valve, and it is inflated.

How to Prevent Aortic Valve Disease?

• Regular monitoring of blood pressure levels.

• Avoid smoking and drinking habits.

• Improve physical activity.

• Maintain a good diet that is rich in nutrition.

• Treat the infection with appropriate antibiotics.

What Are the Complications of Aortic Valve Disease?

The following are possible side effects of aortic valve disease:

• Blood clots

• Stroke.

• Heart failure.

• Arrhythmias (irregularities in the heartbeat).

• Unexpected cardiac arrest leading to death.

Appropriate diagnosis and treatment can lower the chance of complications.

When to Visit a Physician?

Make a call to a local emergency number if one experiences sudden chest pain. If individuals experience any of the following symptoms of aortic valve disease: shortness of breath, fatigue after exertion, pounding in the chest, or irregular heartbeat, schedule a checkup. Heart failure may sometimes be associated with the initial signs of aortic valve disease. If individuals experience shortness of breath, swelling in their ankles and feet, or fatigue that fails to go away with rest, they should see a doctor. These are common signs of heart failure. If individuals experience any symptoms of stroke, contact the physician.

Conclusion:

Aortic valve diseases have a severe impact on the quality of life. The timing of symptom onset considerably influences prognosis. Patients who are asymptomatic and do not manifest symptoms have an increased lifespan. A routine checkup with the cardiologist regarding hypertension and other disorders will help in early management and prevent the advancement of the disease.