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Aortic valve

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Aortic valve is a valve located at the base of the aorta.

Short axis view of the heart with aortic valve
Short axis view of the heart with aortic valve

Anatomy

The valve between the left ventricle and the aorta is the aortic semilunar valve.

Function

When the ventricles contract, atrioventricular valves close to prevent blood from flowing back into the atria. When the ventricles relax, semilunar valves close to prevent blood from flowing back into the ventricles.

Congenital anomalies

Aortic Atresia or aortic stenosis is a rare congenital heart defect in which there is no opening from the left ventricle of the heart into the aorta. This type of obstruction interrupts blood flow from the left ventricle of the heart to the body. Because of this blockage, the only other way for blood to flow to the rest of the body is through another structure in the heart called the ductus ateriosus. Aortic atresia usually occurs in combination with other heart defects, such as hypoplastic left heart syndrome. This combination is the most frequent cause of congestive heart failure and death in the neonatal period (the first 28 days of life).

Aortic stenosis rheumatic
Aortic stenosis rheumatic

Infants with aortic valve atresia surviving into adulthood may develop problems with their heart functioning later in life due to worsening of the condition. Over time, the surgical treatments that were used at infancy to repair the aortic heart valve may leave scar tissue behind, increasing the chances of abnormal heart rhythm (arrhythmia) and an area for infection called SBE (subacute bacterial endocarditis).

Diagnostic testing:

  • Chest x-ray;
  • Electrocardiogram;
  • Echocardiogram;
  • Cardiac catheterization; and
  • Cardiac magnetic resonance imaging (MRI).

Physical findings: The physical findings associated with aortic atresia include:  

  • Cyanosis (blue-tinged skin);
  • Dyspnea (shortness of breath);
  • Rapidly progressive heart failure with hepatomegaly (enlarged liver); and
  • A gallop rhythm.

ICD codes

  • ICD-9: 747.22
  • ICD-10: Q25.2
HUMAN HEART VALVE- AORTIC VALVE REPLACEMENT
HUMAN HEART VALVE- AORTIC VALVE REPLACEMENT

Progression

A diagnosis of aortic atresia is usually made shortly after birth. Disease progression is variable based on the severity of the congenital heart defects and the response to medication and surgical interventions.

Treatment

The treatment of aortic atresia is based on the severity of the condition. Infants are usually treated with medications to keep the ductus arteriosis open, and staged surgical intervention. Adults should be monitored by a cardiologist to assess the need for medication, surgery, and for heart infections (endocarditis) throughout their lifetime.

Aortic regurgitation

When a large amount of blood comes back, the heart must work harder to force out enough blood to meet the body's needs. The left lower chamber of the heart widens (dilates) and the heart beats very strongly (bounding pulse). Over time, the heart becomes less able to supply enough blood to the body.

In the past, rheumatic fever was the main cause of aortic regurgitation. The use of antibiotics to treat strep infections has made rheumatic fever less common. Therefore, aortic regurgitation is more commonly due to other causes. These include: Ankylosing spondylitis Aortic dissection Congenital (present at birth) valve problems, such as bicuspid valve Endocarditis (infection of the heart valves) High blood pressure Marfan syndrome Reiter syndrome (also known as reactive arthritis) Syphilis Systemic lupus erythematosus Trauma to the chest Aortic insufficiency is most common in men between the ages of 30 and 60.

Symptoms of AR

The condition often has no symptoms for many years. Symptoms may come on slowly or suddenly. They may include: Bounding pulse Chest pain similar to angina (rare) Fainting Fatigue Palpitations (sensation of the heart beating) Shortness of breath with activity or when lying down Waking up short of breath some time after falling asleep Swelling of the feet, legs, or abdomen Uneven, rapid, racing, pounding, or fluttering pulse Weakness that is more likely to occur with activity

Diagram of the human heart with valves
Diagram of the human heart with valves

Exams and Tests

Signs may include:

  • Heart murmur that can be heard through a stethoscope
  • Very forceful beating of the heart
  • Bobbing of the head in time with the heartbeat
  • Hard pulses in the arms and legs
  • Low diastolic blood pressure
  • Signs of fluid in the lungs
  • Aortic regurgitation may be seen on tests such as:
  • Aortic angiography
  • Echocardiogram -- ultrasound examination of the heart
  • Left heart catheterization
  • MRI or CT scan of the heart
  • Transthoracic echocardiogram (TTE) or transesophageal echocardiogram (TEE)
  • A chest x-ray may show swelling of the left lower heart chamber.
  • Lab tests cannot diagnose aortic insufficiency. However, they may help rule out other causes.

Treatment

You may not need treatment if you have no symptoms or only mild symptoms. However, you will need to see a health care provider for regular echocardiograms.

If your blood pressure is high, you may need to take blood pressure medicines to help slow the worsening of aortic regurgitation.

Diuretics (water pills) may be prescribed for symptoms of heart failure.

In the past, most people with heart valve problems were given antibiotics before dental work or an invasive procedure, such as colonoscopy. The antibiotics were given to prevent an infection of the damaged heart. However, antibiotics are now used much less often.

Aortic Stenosis - Hemodynamic Pressure Tracing
Aortic Stenosis - Hemodynamic Pressure Tracing

You may need to limit activity that requires more work from your heart. Talk to your provider.

Surgery to repair or replace the aortic valve corrects aortic regurgitation. The decision to have aortic valve replacement depends on your symptoms and the condition and function of your heart.

You may also need surgery to repair the aorta if it is enlarged.

Other names

Semilunar valve

Replacement of aortic valve

The decision to repair or replace heart valves depends on many factors, including:

The severity of your valve disease Whether you need heart surgery for other conditions, such as bypass surgery to treat coronary heart disease.

Repairing Heart Valves

Heart surgeons can repair heart valves by: Adding tissue to patch holes or tears or to increase the support at the base of the valve Removing or reshaping tissue so the valve can close tighter Separating fused valve flaps

Sometimes cardiologists repair heart valves using cardiac catheterization.

Heart valves that cannot open fully (stenosis) can be repaired with surgery or with a less invasive catheter procedure called balloon valvuloplasty. This procedure also is called balloon valvotomy.

During the procedure, a catheter (thin tube) with a balloon at its tip is threaded through a blood vessel to the faulty valve in your heart. The balloon is inflated to help widen the opening of the valve. Your doctor then deflates the balloon and removes both it and the tube. You’re awake during the procedure, which usually requires an overnight stay in a hospital.

Balloon valvuloplasty relieves many symptoms of heart valve disease, but may not cure it. The condition can worsen over time. You still may need medicines to treat symptoms or surgery to repair or replace the faulty valve. Balloon valvuloplasty has a shorter recovery time than surgery. The procedure may work as well as surgery for some patients who have mitral valve stenosis. For these people, balloon valvuloplasty often is preferred over surgical repair or replacement.

Balloon valvuloplasty doesn’t work as well as surgery for adults who have aortic valve stenosis. Doctors often use balloon valvuloplasty to repair valve stenosis in infants and children.

Replacing Heart Valves

Sometimes heart valves can’t be repaired and must be replaced. This surgery involves removing the faulty valve and replacing it with a man-made or biological valve.

Biological valves are made from pig, cow, or human heart tissue and may have man-made parts as well. These valves are specially treated, so you won’t need medicines to stop your body from rejecting the valve.

Man-made valves last longer than biological valves and usually don’t have to be replaced. Biological valves usually have to be replaced after about 10 years, although newer ones may last 15 years or longer. Unlike biological valves, however, man-made valves require you to take blood-thinning medicines for the rest of your life. These medicines prevent blood clots from forming on the valve. Blood clots can cause a heart attack or stroke. Man-made valves also raise your risk of infective endocarditis.

You and your doctor will decide together whether you should have a man-made or biological replacement valve.

If you’re a woman of childbearing age or if you’re athletic, you may prefer a biological valve so you don’t have to take blood-thinning medicines. If you’re elderly, you also may prefer a biological valve, as it will likely last for the rest of your life.

Ross Procedure

Doctors also can treat faulty aortic valves with the Ross procedure. During this surgery, your doctor removes your faulty aortic valve and replaces it with your pulmonary valve. Your pulmonary valve is then replaced with a pulmonary valve from a deceased human donor.

This is more involved surgery than typical valve replacement, and it has a greater risk of complications. The Ross procedure may be especially useful for children because the surgically replaced valves continue to grow with the child. Also, lifelong treatment with blood-thinning medicines isn’t required. But in some patients, one or both valves fail to work well within a few years of the surgery. Researchers continue to study the use of this procedure.

Other Approaches for Repairing and Replacing Heart Valves

Some forms of heart valve repair and replacement surgery are less invasive than traditional surgery. These procedures use smaller incisions (cuts) to reach the heart valves. Hospital stays for these newer types of surgery usually are 3 to 5 days, compared with a 5-day stay for traditional heart valve surgery.

New surgeries tend to cause less pain and have a lower risk of infection. Recovery time also tends to be shorter—2 to 4 weeks versus 6 to 8 weeks for traditional surgery.

TRANSCATHETER VALVE THERAPY

Interventional cardiologists perform procedures that involve threading clips or other devices to repair faulty heart valves using a catheter (tube) inserted through a large blood vessel. The clips or devices are used to reshape the valves and stop the backflow of blood. People who receive these clips recover more easily than people who have surgery. However, the clips may not treat backflow as well as surgery.

Doctors also may use a catheter to replace faulty aortic valves. This procedure is called transcatheter aortic valve replacement (TAVR). For this procedure, the catheter usually is inserted into an artery in the groin (upper thigh) and threaded to the heart. A deflated balloon with a folded replacement valve around it is at the end of the catheter.

Once the replacement valve is placed properly, the balloon is used to expand the new valve so it fits securely within the old valve. The balloon is then deflated, and the balloon and catheter are removed.

A replacement valve also can be inserted in an existing replacement valve that is failing. This is called a valve-in-valve procedure.


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