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Aortic valve stenosis - Aortic stenosis
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Aortic valve stenosis - Aortic stenosis

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HEART & BLOOD

Heart Disease

Causes

Aortic valve stenosis obstructs the way blood normally flows through your heart and its valves. A number of factors can be causes.

Your heart, the center of your circulatory system, consists of four chambers. The two upper chambers, the atria, receive blood. The two lower chambers, the ventricles, pump blood.

Blood returning to your heart enters the right upper chamber (right atrium). From there, blood empties into the right ventricle underneath. The right ventricle pumps blood into your lungs, where blood is oxygenated. Blood from your lungs then returns to your heart, but this time to the left side — to the left upper chamber (left atrium). Blood then flows into the left ventricle underneath — your heart's main pump. With each heartbeat, the left ventricle forces blood through the aortic valve into the aorta, your body's largest artery.

Blood flows through your heart's chambers, aided by four heart valves, which open and close to let blood flow in only one direction through your heart:

  • Tricuspid valve

  • Pulmonary valve

  • Mitral valve

  • Aortic valve

The aortic valve — your heart's gateway to the aorta — consists of three tightly fitting, triangular-shaped flaps of tissues called leaflets. These leaflets connect to the aorta through a ring called the annulus.

Heart valves open like a one-way gate. The leaflets of the aortic valve are forced open as the left ventricle contracts and blood flows into the aorta. When all of the blood has gone through the valve and the left ventricle has relaxed, the leaflets swing closed to prevent the blood that has just passed into the aorta from flowing back into the left ventricle.

A defective heart valve is one that fails either to open or close fully. When a valve doesn't close tightly, blood can leak backward. This backward flow through a valve is called regurgitation. When a valve narrows, the condition is called stenosis.

Aortic stenosis is narrowing of the aortic valve. Many factors can narrow this passageway between your heart and aorta. Causes of aortic stenosis include:

  • Congenital heart defect. Rarely, some babies are born with an already narrowed aortic valve. Others are born with an aortic valve that has only two flaps (leaflets) — not three. Known as a bicuspid aortic valve, this deformity may not cause any problems until adulthood, at which time the valve may begin to narrow or leak and may need to be repaired or replaced. Having a bicuspid aortic valve requires regular evaluation by a doctor to watch for signs of valve malfunction. If you're the parent of a newborn, infant or child with aortic stenosis, you may have many questions and concerns. In most cases, doctors don't know why a heart valve fails to develop properly, and it isn't something you could have prevented.

  • Calcium buildup on the valve. With age, heart valves may accumulate deposits of calcium (aortic valve calcification). Calcium is a mineral found in your blood. As blood repeatedly flows over the aortic valve, deposits of calcium can accumulate on the valve's leaflets. These deposits may never cause any problems. However, in some people — particularly those with a bicuspid aortic valve — calcium deposits result in stiffening of the leaflets of the valve. This stiffening narrows the aortic valve. This cause of aortic stenosis is most common in people older than 60, and symptoms often don't appear until age 70 or 80.

  • Rheumatic fever. Rheumatic fever — a complication of strep throat and a once-common childhood illness — can damage heart valves. Rheumatic fever may result in scar tissue forming on the aortic valve. Scar tissue alone can narrow the aortic valve and lead to aortic stenosis. Scar tissue can also create a rough surface on which calcium deposits can collect, contributing to aortic stenosis later in life. Rheumatic fever may damage more than one heart valve, and in more than one way. A damaged heart valve may not open fully or close fully — or both. Rheumatic fever is still prevalent in underdeveloped countries, and many older adults had rheumatic fever as children.

Aortic stenosis — of any cause — can be a serious condition because it can weaken the heart. If the aortic valve is narrowed, the left ventricle has to work harder to pump a sufficient amount of blood into the aorta and onward to the rest of your body. In response, the left ventricle may thicken and enlarge. At first these adaptations help the left ventricle pump blood with more force. But eventually these changes weaken the left ventricle — and your heart overall.

Risk factors

Aortic stenosis is often not preventable. Some people are born with an already narrowed aortic valve or develop aortic stenosis later in life because they were born with a bicuspid aortic valve — one with two flaps (leaflets) instead of three. A bicuspid aortic valve is a major risk factor for aortic stenosis.

Aortic stenosis also may be related to age and the buildup of calcium deposits on heart valves or a history of rheumatic fever. There's some evidence that lowering cholesterol can help prevent calcification of the aortic valve. If you have aortic stenosis and high cholesterol, your doctor may recommend cholesterol-lowering medication.

 

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Last Modified : 03/14/08 06:53 PM