Aortic Stenosis and Aortic Regurgitation
What does the aortic valve do?
The aortic valve lies between the left ventricle and the aorta. It opens when the heart contracts to allow blood to reach the body, and closes during relaxation to prevent blood from flowing backwards. The two main abnormalities are narrowing, called aortic stenosis, and leakage, called aortic regurgitation. They may occur separately or together.
Aortic stenosis
What is it?
Aortic stenosis limits valve opening and increases the pressure the left ventricle must generate to pump blood. Over time, the heart muscle may thicken and its function may deteriorate.
What causes it?
Common causes include age-related calcification and a congenital bicuspid aortic valve. Rheumatic valve disease is another possible cause.
What are the symptoms?
Symptoms may include breathlessness during exertion, chest pressure, dizziness, fainting and reduced exercise capacity. Severe disease can remain symptom-free for a time. New symptoms in someone with known severe stenosis are particularly important.
How is it assessed?
Echocardiography measures blood flow velocity, pressure gradients and valve area, together with ventricular function. Severity is assessed using several measurements, rather than one number alone. Selected patients may need exercise testing, CT assessment or additional tests, especially when measurements disagree.
How is it treated?
Follow-up is appropriate for many patients without an indication for intervention. Medicines can treat associated blood pressure problems, coronary disease or heart failure, but do not remove the mechanical narrowing.
When intervention is indicated, options include surgical aortic valve replacement and transcatheter aortic valve implantation (TAVI). Choice depends on age, anatomy, surgical risk, life expectancy, associated aortic disease and patient preferences after specialist assessment.
Aortic regurgitation
What is it?
Aortic regurgitation occurs when the valve does not close completely and blood flows back from the aorta into the left ventricle. Chronic significant regurgitation causes volume overload and may enlarge the ventricle.
What causes it?
Causes include bicuspid valve disease, degeneration, rheumatic disease, infective endocarditis and enlargement of the aortic root. Acute severe regurgitation can occur with endocarditis or aortic dissection and may be life-threatening.
What symptoms can occur?
Chronic regurgitation may remain silent for years. Later symptoms include breathlessness, fatigue, palpitations and reduced exercise tolerance. Acute severe leakage may cause sudden breathlessness and circulatory instability.
How is it diagnosed?
Echocardiography assesses the mechanism and severity of leakage, left ventricular size and pumping function, and aortic dimensions. Cardiac MRI may clarify regurgitant volume and ventricular measurements when needed. CT or MRI may be used for the aorta.
How is it treated?
Mild disease may require monitoring. Associated hypertension and heart failure should be treated. Surgery may be indicated when regurgitation is severe and symptoms develop, ventricular size increases or ventricular function declines, or when associated aortic disease requires intervention. Selected patients may be considered for catheter-based treatment after specialised assessment.
Why is follow-up important?
A person can feel well while valve disease affects the heart. Follow-up intervals depend on severity, ventricular measurements, aortic dimensions and changes in symptoms. Do not wait for severe symptoms before attending recommended checks.
When should you seek urgent help?
Fainting, ongoing chest pain, sudden severe breathlessness or sudden severe chest/back pain requires emergency assessment. Call 112.
Assoc. Prof. Sezen Bağlan Uzunget, MD — Cardiologist
This information is educational. Valve intervention decisions require individual evaluation.
Türkçe: Aort Kapak Darlığı ve Yetersizliği