To diagnose aortic valve stenosis, your health care provider will examine you and ask questions about your symptoms and medical history. The provider will listen to your heart with a stethoscope to determine if you have a heart murmur related to an aortic valve condition.
Your health care provider may order several tests to confirm or rule out aortic valve stenosis. Tests also can help determine a cause and the condition's severity.
Tests for aortic valve stenosis may include:
Echocardiogram. An echocardiogram uses sound waves to create pictures of the beating heart. It shows how blood flows through the heart and heart valves. It can help identify a weakened heart muscle and determine the severity of aortic valve stenosis.
Sometimes, a special type of echocardiogram called transesophageal echocardiogram (TEE) may be done to get a closer look at the aortic valve. In this test, a flexible tube containing the ultrasound probe is guided down the throat and into the esophagus and placed closed to the heart.
- Electrocardiogram (ECG or EKG). This painless test measures the electrical activity of the heart. During an ECG, sensors (electrodes) are attached to the chest and sometimes to the arms or legs. An ECG can show how fast or slow the heart is beating. Your health care provider can look for signal patterns related to heart disease or swelling of the heart's chambers.
- Chest X-ray. A chest X-ray shows the condition of the heart and lungs. It can help determine whether the heart is enlarged, which can occur in aortic valve stenosis. It can also show swelling of the aorta and calcium buildup on the aortic valve.
- Exercise tests or stress tests. These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored. Exercise tests help determine whether symptoms of aortic valve disease occur during physical activity. If you're unable to exercise, medications that have similar effects as exercise on your heart may be used.
- Cardiac computerized tomography (CT) scan. A cardiac CT scan combines several X-ray images to provide a more detailed cross-sectional view of the heart. This test can help measure the size of the aorta and provide details about the aortic valve.
- Cardiac magnetic resonance imaging (MRI) scan. A cardiac MRI uses magnetic fields and radio waves to create detailed images of the heart. This test can show the size of the aorta. It may be used to determine the severity of aortic valve stenosis.
Cardiac catheterization. This test isn't often used to diagnose aortic valve disease, but it may be used if other tests aren't able to diagnose the condition or to determine its severity. It may also be used before aortic valve surgery to make sure the arteries that feed the heart muscle (coronary arteries) are not blocked.
In this procedure, a long, thin flexible tube (catheter) is inserted in a blood vessel, usually in the groin or wrist, and guided to the heart. Dye flows through the catheter to arteries in the heart. This is called a coronary angiogram. The dye helps the arteries show up more clearly on X-ray images and video. During the test, the pressure inside the heart chambers can be measured.
After testing confirms a diagnosis of aortic valve disease, your health care provider may tell you the stage of disease. Staging helps determine the most appropriate treatment.
Heart valve disease is staged into four basic groups:
- Stage A: At risk. Risk factors for heart valve disease are present.
- Stage B: Progressive. Valve disease is mild or moderate. There are no heart valve symptoms.
- Stage C: Asymptomatic severe. There are no heart valve symptoms but the valve disease is severe.
- Stage D: Symptomatic severe. Heart valve disease is severe and is causing symptoms.
The stage of heart valve disease depends on many things, including symptoms, disease severity, the structure of the valve or valves, and blood flow through the heart and lungs.
Treatment for aortic valve stenosis depends on the symptoms and the severity of the condition.
If you have mild aortic valve symptoms or none, you may only need regular checkups by a health care provider. The provider may recommend healthy lifestyle changes and medications to treat valve disease symptoms or reduce the risk of complications.
Surgery or other procedures
Biological valve replacement
Biological valve replacement
In a biological valve replacement, a biological or tissue valve replaces the damaged valve.
Mechanical valve replacement
Mechanical valve replacement
In a mechanical valve replacement, a mechanical valve replaces the damaged valve.
Transcatheter aortic valve replacement (TAVR)
Transcatheter aortic valve replacement (TAVR)
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace a narrowed aortic valve that fails to open properly (aortic valve stenosis). In this procedure, surgeons insert a catheter into the leg or chest and guide it to the heart. A replacement valve is inserted through the catheter and guided to the heart. A balloon is expanded to press the valve into place. Some TAVR valves are self-expanding.
You may eventually need surgery to repair or replace the diseased aortic valve, even if you don't have symptoms. Aortic valve surgery may be done at the same time as other heart surgery.
Surgery to repair or replace an aortic valve is usually done through a cut (incision) in the chest. Less invasive approaches may be available. Ask your health care provider which type of procedure is best for you. Aortic valve surgery may be done at the same time as other heart surgery.
Surgery options for aortic valve stenosis include:
Balloon valvuloplasty. This procedure can treat aortic valve stenosis in infants and children. In adults, the aortic valve tends to narrow again after the procedure. So it's usually only done if you're too ill for surgery or you're waiting for a valve replacement, because additional procedures are typically needed to treat the narrowed valve over time.
In this procedure, a long, thin tube (catheter) with a balloon on the tip is inserted into an artery in the arm or groin. It's guided to the aortic valve. Once in place, the balloon is inflated, which widens the valve opening. The balloon is then deflated, and the catheter and balloon are removed.
Aortic valve replacement. Aortic valve replacement is often needed to treat aortic valve stenosis. In aortic valve replacement, the surgeon removes the damaged valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve). Sometimes, the aortic valve is replaced with the person's own lung (pulmonary) valve. The pulmonary valve is replaced with a biological lung tissue valve from a deceased donor This more complicated surgery is called the Ross procedure.
Biological tissue valves break down over time and may eventually need to be replaced. People with mechanical valves will need to take blood-thinning medications for life to prevent blood clots. Your health care provider will discuss with you the benefits and risks of each type of valve.
Transcatheter aortic valve replacement (TAVR). TAVR is an alternative to open-heart aortic valve replacement surgery. This minimally invasive procedure replaces a narrowed aortic valve with a valve made of cow or pig tissue. It may be an option if you're at intermediate or high risk of complications from surgical aortic valve replacement. Ask your health care provider about your options.
TAVR is done using smaller incisions and a thin, flexible tube (catheter) to reach the heart. A flexible tube (catheter) is inserted into a blood vessel and guided to the heart. A replacement valve made of cow or pig tissue is passed through the catheter to the aortic valve area. A balloon on the catheter tip inflates to press the new valve into place. Some valves can self-expand. The surgeon removes the catheter once the new valve is securely in place. Surgeons may also perform a catheter procedure to insert a replacement valve into a biological tissue valve that is no longer working properly.
- Aortic valve repair. To repair an aortic valve, surgeons separate valve flaps (cusps) that have fused. However, valve repair is rarely used to treat aortic valve stenosis. Generally aortic valve stenosis requires aortic valve replacement.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.
Lifestyle and home remedies
If you have aortic valve stenosis, you'll likely need regular health checkups. Continue taking all your medications as prescribed.
Making certain lifestyle changes can help keep the heart healthy and may prevent or slow heart disease. Try these heart-healthy tips:
- Don't smoke. If you smoke, quit. Ask your provider about resources to help you quit smoking. Joining a support group may be helpful.
- Eat a heart-healthy diet. Eat a variety of fruits and vegetables, low-fat or fat-free dairy products, poultry, fish, and whole grains. Avoid saturated and trans fat, and excess salt and sugar.
- Maintain a healthy weight. Aim to keep a healthy weight. Lose weight if you're overweight or have obesity. Losing just a few pounds can help reduce risk factors for heart disease. Talk to your provider about the weight that's best for you.
- Get regular exercise. Exercise helps manage weight and control risk factors for heart disease. Aim to get about 30 minutes of physical activity, such as brisk walks, each day.
- Manage stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness, spending time with family and friends, and connecting with others in support groups are some ways to reduce stress.
Pregnancy and aortic valve disease
If you have aortic stenosis and are considering pregnancy, it's important to talk to your health care provider about your plans. Together, you and your health care provider can discuss the safety of medications and whether you need a procedure to treat aortic valve stenosis before getting pregnant.
Those with heart valve disease such as aortic valve stenosis usually require close monitoring by a health care provider during pregnancy. Care providers may recommend avoiding pregnancy due to the risk of complications if you have severe aortic stenosis.
Preparing for your appointment
If you think you have aortic valve stenosis, consider being evaluated and treated at a medical center with a multidisciplinary heart valve team. This is a team of heart doctors (cardiologists) and other care providers trained and experienced in evaluating and treating heart valve disease.
Here's some information to help you prepare for your appointment.
What you can do
- Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do beforehand.
- Write down your symptoms, including any that seem unrelated to heart valve disease.
- Write down key personal information, including a family history of heart disease and any major stresses or recent life changes.
- Make a list of all medications, vitamins and supplements you take.
- Take a family member or friend along, if possible. Someone who goes with you can help you remember information you receive.
- Be prepared to discuss your diet and exercise habits. If you don't already eat well and exercise, be ready to talk to your health care provider about challenges you might face in getting started.
- Write down questions to ask your care provider.
For aortic valve stenosis, some basic questions to ask your health care provider include:
- What is likely causing my symptoms or condition?
- What are other possible causes for my symptoms or condition?
- What tests will I need?
- What's the best treatment?
- What are the alternatives to the primary approach you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there restrictions I need to follow?
- Should I see a specialist?
- If I need surgery, which surgeon do you recommend for heart valve surgery?
- Is there a generic alternative to the medicine you're prescribing?
- Are there brochures or other printed material I can take with me? What websites do you recommend?
Don't hesitate to ask other questions you have.
What to expect from your doctor
Your health care provider is likely to ask you a number of questions, including:
- When did your symptoms begin?
- Do you always have symptoms or do they come and go?
- How severe are your symptoms?
- What, if anything, improves your symptoms?
- What, if anything, worsens your symptoms?
Aug. 18, 2022