Aortic valve stenosis

Aortic valve stenosis or aortic stenosis is a heart condition where the heart’s aortic valve narrows making it harder for the heart to pump blood through the aortic valve. The word stenosis means constriction or narrowing. In aortic stenosis, the aortic valve is narrowed.

The aortic valve is like a one-way door leading out of the heart. The aortic valve sits between the left ventricle and the aorta, which is the artery that carries blood from the heart to the rest of the body. The aortic valve must open fully and close fully with each heartbeat so the heart can pump enough blood around the body.

About 4 in 1,000 people have a congenital valvular disease (most commonly a valve with two cusps) which may lead to the development of aortic valve stenosis by a younger age – e.g. around 30 years of age. Approximately 40% of patients with the condition rheumatic heart disease will have aortic valve involvement. In addition, many elderly people (> 65 years of age) can have degenerative aortic valve stenosis caused by atherosclerosis and calcification of the aortic valve, although only some will have symptoms.

In aortic valve stenosis the opening is narrowed, the heart must work much harder to try and deliver enough blood to the body and can become overworked. As a result of all this strain on your heart, this in turn leads to increased demand for blood and oxygen from the heart and possibly leads to subsequent angina, irregular heart rhythms or heart failure. Arrhythmias such as atrial fibrillation are often precipitated by the changes to the left ventricle. The end result is left ventricular failure. Symptoms of failure usually begin to occur when the valvular orifice size is reduced to less than 1/3 of normal.

Your heart might be straining if you are short of breath, tired or notice a build-up of fluid in the body.

Aortic valve stenosis life expectancy

The outcome and life expectancy varies. The aortic valve stenosis may be mild and not produce symptoms. Over time, the aortic valve may become narrower. This may result in more severe heart problems such as:

• Atrial fibrillation and atrial flutter
• Blood clots to the brain (stroke), intestines, kidneys, or other areas
• Fainting spells (syncope)
• Heart failure
• High blood pressure in the arteries of the lungs (pulmonary hypertension)

The prognosis of untreated aortic valve stenosis once symptoms have begun is poor, with the average life expectancy of a few years. However surgical treatments can usually halt the natural history of the disease before end stage heart failure has set in.

Aortic valve stenosis complications

• Heart failure
• Stroke
• Blood clots
• Bleeding
• Heart rhythm abnormalities (arrhythmias)
• Infections that affect the heart, such as endocarditis
• Death

What are heart valves ?

Your heart is a strong muscle about the size of the palm of your hand. Your body depends on the heart’s pumping action to deliver oxygen- and nutrient-rich blood to the body’s cells. When the cells are nourished properly, the body can function normally. Just like an engine makes a car go, the heart keeps your body running. The heart has two pumps separated by an inner wall called the septum. The right side of the heart pumps blood to the lungs to pick up oxygen. The left side of the heart receives the oxygen-rich blood from the lungs and pumps it to the body.

The heart has four chambers ¹, two on the right and two on the left:

• Two upper chambers are called atrium (two is called an atria). The atria collect blood as it flows into the heart.
• Two lower chambers are called ventricles. The ventricles pump blood out of the heart to the lungs or other parts of the body.

The heart also has four valves that open and close to let blood flow from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart in only one direction when the heart contracts (beats). The four heart valves are:

• Tricuspid valve, located between the right atrium and right ventricle
• Pulmonary or pulmonic valve, between the right ventricle and the pulmonary artery. This artery carries blood from the heart to the lungs.
• Mitral valve, between the left atrium and left ventricle
• Aortic valve, between the left ventricle and the aorta. This aorta carries blood from the heart to the rest of the body.

Each valve has a set of flaps (also called leaflets or cusps). The mitral valve has two flaps; the others have three. Valves are like doors that open and close. They open to allow blood to flow through to the next chamber or to one of the arteries. Then they shut to keep blood from flowing backward. Blood flow occurs only when there’s a difference in pressure across the valves, which causes them to open. Under normal conditions, the valves permit blood to flow in only one direction.

The heart four chambers and four valves and is connected to various blood vessels. Veins are blood vessels that carry blood from the body to the heart. Arteries are blood vessels that carry blood away from the heart to the body.

The heart pumps blood to the lungs and to all the body’s tissues by a sequence of highly organized contractions of the four chambers. For the heart to function properly, the four chambers must beat in an organized way.

When the heart’s valves open and close, they make a “lub-DUB” sound that a doctor can hear using a stethoscope ².

• The first sound—the “lub”—is made by the mitral and tricuspid valves closing at the beginning of systole. Systole is when the ventricles contract, or squeeze, and pump blood out of the heart.
• The second sound—the “DUB”—is made by the aortic and pulmonary valves closing at the beginning of diastole. Diastole is when the ventricles relax and fill with blood pumped into them by the atria.

Figure 1. The anatomy of the heart valves

Figure 2. Top view of the 4 heart valves

Figure 3.  Normal heart blood flow

Figure 4. Heart valves function

Figure 5. Aortic valve stenosis

Note: In aortic valve stenosis, there is progressive narrowing of the aortic valve opening over time (top row), which results in increased pressure within the heart and reduced capacity to pump blood to the body. This is similar to attaching smaller and smaller nozzles to the end of a garden hose (bottom row). The narrowing from the nozzle slows the forward flow of water and results in progressive pressure buildup within the garden hose.

Heart valves function

The Right Side of Your Heart

In figure 3 above, the superior and inferior vena cavae are shown in blue to the left of the heart muscle as you look at the picture. These veins are the largest veins in your body.

After your body’s organs and tissues have used the oxygen in your blood, the vena cavae carry the oxygen-poor blood back to the right atrium of your heart.

The superior vena cava carries oxygen-poor blood from the upper parts of your body, including your head, chest, arms, and neck. The inferior vena cava carries oxygen-poor blood from the lower parts of your body.

The oxygen-poor blood from the vena cavae flows into your heart’s right atrium.  From the right atrium, blood is pumped into the right ventricle. And then from the right ventricle, blood is pumped to your lungs through the pulmonary arteries (shown in blue in the center of figure 3).

Once in the lungs, the blood travels through many small, thin blood vessels called capillaries. There, the blood picks up more oxygen and transfers carbon dioxide to the lungs—a process called gas exchange.

The oxygen-rich blood passes from your lungs back to your heart through the pulmonary veins (shown in red to the left of the right atrium in figure 3).

The Left Side of Your Heart

Oxygen-rich blood from your lungs passes through the pulmonary veins (shown in red to the right of the left atrium in figure 3 above). The blood enters the left atrium and is pumped into the left ventricle.

From the left ventricle, the oxygen-rich blood is pumped to the rest of your body through the aorta. The aorta is the main artery that carries oxygen-rich blood to your body.

Like all of your organs, your heart needs oxygen-rich blood. As blood is pumped out of your heart’s left ventricle, some of it flows into the coronary arteries (shown in red in figure 3).

Your coronary arteries are located on your heart’s surface at the beginning of the aorta. They carry oxygen-rich blood to all parts of your heart.

For the heart to work well, your blood must flow in only one direction. Your heart’s valves make this possible. Both of your heart’s ventricles have an “in” (inlet) valve from the atria and an “out” (outlet) valve leading to your arteries.

Healthy valves open and close in exact coordination with the pumping action of your heart’s atria and ventricles. Each valve has a set of flaps called leaflets or cusps that seal or open the valve. This allows blood to pass through the chambers and into your arteries without backing up or flowing backward.

Aortic valve stenosis causes

Around 4 in 1000 people are born with an aortic valve that is shaped differently, with only two cusps (flaps) instead of three (see Figure 2). These people can get aortic stenosis earlier in life. But the most common cause of aortic stenosis is that the aortic valve can get hardened or scarred as people get older. Aortic valve stenosis occurs in about 2% of people over 65 years of age. It occurs more often in men than in women.

Calcium buildup of the aortic valve happens sooner in people who are born with abnormal aortic or bicuspid valves. In rare cases, calcium buildup can develop more quickly when a person has received chest radiation (such as for cancer treatment).

After a bicuspid aortic valve has been diagnosed, you’ll need lifelong care from a pediatric cardiologist as a child, and then from an adult congenital cardiologist as an adult, including regular follow-up appointments to monitor for any changes in your condition.

A bicuspid aortic valve can be inherited in families. Because of this, doctors often recommend that all first-degree relatives — parents, children and siblings — of people with a bicuspid aortic valve be screened with an echocardiogram.

A less common cause of aortic stenosis is rheumatic heart disease. This condition can develop after strep throat or scarlet fever. Valve problems do not develop for 5 to 10 years or longer after rheumatic fever occurs. Rheumatic fever is becoming rarer in the United States.

Risk Factors for aortic valve stenosis

The most common predisposing factors are:

• Certain heart conditions present at birth (congenital heart disease) such as a bicuspid aortic valve;
• Rheumatic heart disease;
• Old age;
• History of infections that can affect the heart;
• Having cardiovascular risk factors, such as diabetes, high cholesterol and high blood pressure;
• Chronic kidney disease;
• History of radiation therapy to the chest.

It should be noted that a clinically similar picture can be produced by obstruction to left ventricular outflow at either above or below the valve.

Bicuspid aortic valve

Some people are born with a bicuspid aortic valve, in which the aortic valve — located between the lower left heart chamber (left ventricle) and the main artery that leads to the body (aorta) — has only two (bicuspid) cusps instead of three. People may also be born with one (unicuspid) or four (quadricuspid) cusps, but these are rare.

A bicuspid aortic valve may cause the heart’s aortic valve to narrow (aortic valve stenosis). This narrowing prevents the valve from opening fully, which reduces or blocks blood flow from the heart to the body. In some cases, the aortic valve doesn’t close tightly, causing blood to leak backward into the left ventricle (aortic valve regurgitation). Most people with a bicuspid aortic valve aren’t affected by valve problems until they’re adults, and some may not be affected until they’re older adults. Some children with bicuspid aortic valves may have valve problems.

Some people with a bicuspid aortic valve may have an enlarged aorta — the main blood vessel leading from the heart. There is also an increased risk of aortic dissection.

Children and adults with a bicuspid aortic valve will require regular monitoring for any changes in their condition, such as valve problems or an enlarged aorta, by doctors trained in congenital heart disease (congenital cardiologists).

You may eventually need treatment for valve problems such as aortic valve stenosis, aortic valve regurgitation or an enlarged aorta.

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 build up on the valve’s cusps. These calcium deposits aren’t linked to taking calcium tablets or drinking calcium-fortified drinks.

These deposits may never cause any problems. However, in some people — particularly those with a congenitally abnormal aortic valve, such as a bicuspid aortic valve — calcium deposits result in stiffening of the cusps of the valve. This stiffening narrows the aortic valve and can occur at a younger age.

However, aortic valve stenosis that is related to increasing age and the buildup of calcium deposits on the aortic valve is most common in older people. It usually doesn’t cause symptoms until ages 70 or 80.

Rheumatic fever

A complication of strep throat infection, rheumatic fever may result in scar tissue forming on the aortic valve. Scar tissue alone can narrow the aortic valve and lead to aortic valve stenosis. Scar tissue can also create a rough surface on which calcium deposits can collect, contributing to aortic valve 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. While rheumatic fever is rare in the United States, some older adults had rheumatic fever as children.

Aortic valve stenosis prevention

Some possible ways to prevent aortic valve stenosis include:

• Taking steps to prevent rheumatic fever. You can do this by making sure you see your doctor when you have a sore throat. Untreated strep throat can develop into rheumatic fever. Fortunately, strep throat can usually be easily treated with antibiotics. Rheumatic fever is more common in children and young adults.
• Addressing risk factors for coronary artery disease. These include high blood pressure, obesity and high cholesterol levels. These factors may be linked to aortic valve stenosis, so it’s a good idea to keep your weight, blood pressure and cholesterol levels under control if you have aortic valve stenosis.
• Taking care of your teeth and gums. There may be a link between infected gums (gingivitis) and infected heart tissue (endocarditis). Inflammation of heart tissue caused by infection can narrow arteries and aggravate aortic valve stenosis.

Once you know that you have aortic valve stenosis, your doctor may recommend that you limit strenuous activity to avoid overworking your heart.

Aortic valve stenosis symptoms

Some people with aortic stenosis don’t have any symptoms, especially if the valve is only a little narrower.

Most people with aortic stenosis do not develop symptoms until the disease is advanced. The diagnosis may have been made when the health care provider heard a heart murmur and performed tests.

Others have:

• Palpitations (heart racing or skipping a beat)
• Fainting, weakness, or dizziness with exercise
• Feeling tired or worn out
• Chest pain
• Feeling short of breath
• Chest discomfort: The chest pain may get worse with activity and reach into the arm, neck, or jaw. The chest may also feel tight or squeezed.
• Cough, possibly bloody.
• Breathing problems when exercising.
• Becoming easily tired.

In infants and children, symptoms include:

• Becoming easily tired with exertion (in mild cases)
• Failure to gain weight
• Poor feeding
• Serious breathing problems that develop within days or weeks of birth (in severe cases)

Children with mild or moderate aortic stenosis may get worse as they get older. They are also at risk for a heart infection called bacterial endocarditis.

People with aortic stenosis may have a past history of rheumatic fever and have symptoms of atrial fibrillation – palpitations. Early in the disease, they may experience:

• Exercise-induced fainting;
• Angina; and
• Dyspnea (shortness of breath).

Later in the aortic valve stenosis disease, these progress to frank heart failure with dyspnea, orthopnoea (shortness of breath while lying flat), and paroxysmal nocturnal dyspnea (waking up gasping for breath).

Occasionally, they may present with myocardial infarction (heart attack). If you’re having symptoms like this, it’s a good idea to see your doctor.

Aortic valve stenosis diagnosis

Your doctor will ask you questions and examine you. They might or might not hear a heart murmur when they listen to your heart.

A heart murmur, click, or other abnormal sound is almost always heard through a stethoscope. The provider may be able to feel a vibration or movement when placing a hand over the heart. There may be a faint pulse or changes in the quality of the pulse in the neck.

Blood pressure may be low.

Depending on what they find, you might be asked to have tests such as an ECG (electrocardiogram), a chest X-ray and an echocardiogram, which is an ultrasound of the heart.

A chest X-ray can sometimes show a scarred aortic valve. An ECG gives valuable information about your heart, including if your left ventricle is enlarged from the effort of pumping blood through a narrowed valve. An echocardiogram shows how efficiently your heart is pumping and whether any of the valves are narrowed.

Electrocardiogram (ECG). In this test, wires (electrodes) attached to pads on your skin measure the electrical activity of your heart. An ECG can detect enlarged chambers of your heart, heart disease and abnormal heart rhythms.

Chest X-ray. A chest X-ray can help your doctor determine whether your heart is enlarged, which can occur in aortic valve stenosis. It can also show whether you have an enlarged blood vessel (aorta) leading from your heart or any calcium buildup on your aortic valve. A chest X-ray can also help doctors determine the condition of your lungs.

Exercise tests or stress tests. Exercise tests help doctors see whether you have signs and symptoms of aortic valve disease during physical activity, and these tests can help determine the severity of your condition. If you are 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 uses a series of X-rays to create detailed images of your heart and heart valves. Doctors may use this test to measure the size of your aorta and look at your aortic valve more closely.

Cardiac MRI. A cardiac MRI uses magnetic fields and radio waves to create detailed images of your heart. This test may be used to determine the severity of your condition and evaluate the size of your aorta.

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.

In this procedure, your doctor threads a thin tube (catheter) through a blood vessel in your arm or groin and guides it to an artery in your heart.

Doctors may inject a dye through the catheter, which helps your arteries become visible on an X-ray (coronary angiogram). This provides your doctor with a detailed picture of your heart arteries and how your heart functions. It can also measure the pressure inside your heart chambers.

Aortic valve stenosis treatment

If you are affected by aortic stenosis, your doctor might advise you not to overexert yourself.

People with severe aortic stenosis may be told not to play competitive sports, even if they have no symptoms. If symptoms do occur, strenuous activity must often be limited.

If you have no symptoms from your aortic stenosis, your doctor may just want you to have regular check-ups.

Some people with aortic stenosis need an operation to remove the aortic valve and replace it with an artificial one. Another operation is sometimes done where your own valve is opened up with a tiny balloon. But this doesn’t work as well as replacing the valve.

Children with aortic stenosis can sometimes get their aortic valve repaired. However, if the valve is very abnormal it is better to replace it with a new one. Using a balloon to stretch the valve can help for a while, but over time the valve can become narrow again, meaning another operation might need to be done.

General treatment:

• Avoidance of strenous activity as this increases demand on the heart.
• Treating angina with beta blockers such as vasodilators may aggravate syncope.
• Antibiotic prophylaxis against infective endocarditis.

Surgery to repair or replace the valve is often done for adults or children who develop symptoms. Even if symptoms are not very bad, the doctor may recommend surgery based on test results. The results of aortic valve replacement are often excellent. To get the best treatment, go to a center that regularly performs this type of surgery.

A less invasive procedure called balloon valvuloplasty may be done instead of or before surgery.

• A balloon is placed into an artery in the groin, threaded to the heart, placed across the valve, and inflated. However, narrowing often occurs again after this procedure.
• A newer procedure done at the same time as valvuloplasty can implant an artificial valve. This procedure is most often done in patients who cannot have surgery, but it is becoming more common.

Some children may need aortic valve repair or replacement. Children with mild aortic stenosis may be able to take part in most activities.

• Aortic valve replacement

In aortic valve replacement, your 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). Another type of biological tissue valve replacement that uses your own pulmonary valve is sometimes possible.

Biological tissue valves degenerate 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 doctor will discuss with you the benefits and risks of each type of valve and discuss which valve may be appropriate for you.

Doctors may perform a less invasive procedure called transcatheter aortic valve replacement (TAVR) to replace a narrowed aortic valve. TAVR may be an option for people who are considered to be at intermediate or high risk of complications from surgical aortic valve replacement.

In transcatheter aortic valve replacement, doctors insert a catheter in your leg or chest and guide it to your heart. A replacement valve is then inserted through the catheter and guided to your heart. A balloon may expand the valve, or some valves can self-expand. When the valve is implanted, doctors remove the catheter from your blood vessel.

Doctors may also conduct a catheter procedure to insert a replacement valve into a failing biological tissue valve that is no longer working properly. Other catheter procedures to repair or replace aortic valves continue to be researched.

Figure 6. Transcatheter aortic valve replacement (TAVR)

• Balloon valvuloplasty

In a balloon valvuloplasty, a doctor inserts a catheter with a balloon on the tip into an artery in your groin and guides it to the aortic valve. Your doctor then inflates the balloon, which expands the opening of the valve. The balloon is then deflated, and the catheter and balloon are removed. The procedure can treat aortic valve stenosis in infants and children, but the valve tends to narrow again in adults who have the procedure. Along with relief of stenosis, some people may have an increased amount of aortic regurgitation after the procedure.

• Aortic valve repair

Aortic valve repair isn’t often performed to treat a bicuspid aortic valve. To repair an aortic valve, surgeons may separate valve flaps (cusps) that have fused, or reshape or remove excess valve tissue so that the cusps can close tightly.

• Aortic root and ascending aorta surgery

In this procedure, surgeons remove the enlarged section of the aorta located near the heart. Surgeons then replace it with a synthetic tube (graft), which is sewn into place. The aortic valve can also be replaced or repaired during this procedure.

In some cases, doctors may replace the enlarged section of the aorta and the aortic valve remains in place.

What happens during the aortic valve stenosis surgery

The standard procedure is done under a general anesthetic, so you will be completely unconscious.

The surgeon will cut through your breastbone to reach your heart and a machine will take over the working of your heart and lungs during surgery.

The faulty valve will be replaced with a biological valve made of human or animal tissue, or a mechanical valve made of metal. During the surgery you may need a blood transfusion.

Newer techniques involve smaller cuts or no cuts to the chest wall. Your doctor will be able to discuss the risks and benefits of each procedure with you.

What to expect after the aortic valve stenosis surgery

You will be taken to the intensive care unit for monitoring, then to a ward until you are ready to leave hospital.

Full recovery from aortic valve replacement can take from several weeks to months, during which you may have pain and tiredness.

You will need to take anti-clotting medication for life if you receive a mechanical valve, or for a few months after receiving a biological valve.

What can go wrong with aortic valve stenosis surgery?

Possible risks include:

• bleeding
• infection
• poor healing of the wound
• changes to your heart rhythm
• damage to your heart
• problems with your kidneys or lungs, particularly if you have a pre-existing condition.

Aortic valve stenosis treatment without surgery

Medicines are used to treat symptoms of heart failure or abnormal heart rhythms (most commonly atrial fibrillation). These include diuretics (water pills), nitrates, and beta-blockers. High blood pressure should also be treated. If aortic stenosis is severe, this treatment must be done carefully so blood pressure does not drop too far.

People with even mildly abnormal aortic valves are at risk for bacterial endocarditis. That’s why it’s important for you to keep your mouth clean and healthy with regular dental check ups. Getting antibiotics before dental procedures isn’t proven to be beneficial and so isn’t universally recommended any more. But if you have a prosthetic valve, you’ll need to take antibiotics before dental work. Your cardiologist can provide you more information and can answer your questions about preventing endocarditis.

In the past, most people with heart valve problems were given antibiotics before dental work or a procedure such as colonoscopy. The antibiotics were given to prevent an infection of the damaged heart. However, antibiotics are now used much less often before dental work and other procedures. Check with your health care provider to find out whether you need antibiotics.

People with this and other heart conditions should stop smoking and be tested for high cholesterol.

Physical Activity Restrictions

Physical exercise has many benefits and should be a regular part of almost anyone’s life. That includes most people with congenital heart disease.

• If you have a severely obstructed valve, vigorous exercise is not a good idea. Your cardiologist may tell you to limit your activity if this is the case. Ask your cardiologist about your exercise limits.

There is no proven link between exercise and harmful outcome from aortic valve stenosis causing an enlarged aorta, but many physicians feel that such patients shouldn’t engage in strenuous exercise, particularly activity that involves straining or grunting like heavy weight lifting ³.

• It’s likely that for most patients, the benefits of exercise outweigh the perceived risks. Low-intensity activity is still preferred. If you have any questions about the appropriateness of exercise for you, talk to your doctor.

If you’ve been inactive for a long time and want to start a regular exercise routine, it’s often wise to talk with your doctor about how to get started safely. Your doctor may recommend an exercise test which can provide you with guidelines for exercise.

Physical activities for children

If the aortic valve is abnormally formed but has no important obstruction or leak, your child may not need any special precautions regarding physical activities and may be able to participate in normal activities without increased risk. Some children with obstruction, leak or heart muscle abnormalities may have to limit how much they do some kinds of exercise. Check with your child’s pediatric cardiologist about this.

What types and how much?

The best and safest types of exercise are “aerobic” activities. These increase the heart rate and make you breath heavily. Examples include brisk walking, swimming, biking, jogging, rowing, cross-country skiing, hiking or stair climbing. Team or court sports such as basketball, soccer, football, tennis, squash and volleyball are also aerobic activities.

A good rule of thumb is to increase your activity so you breathe hard and fast but can still carry on a conversation with someone. If you can speak in full sentences but still feel your heart pounding, you’re likely benefiting from a safe level of activity.

Often patients are trained to check their heart rate during or immediately after activity. Their target heart rate is 70-80 percent of their predicted maximal heart rate (defined as 220 minus age).

It’s best to avoid activities that cause grunting or straining (medically referred to as a “valsalva maneuver”). This happens when a person bears down against a closed throat to increase the strength of arm or abdominal muscles. There’s often a tendency to do this when lifting heavy weights, doing sit-ups, push-ups or chin-ups, etc., but it may be harmful. Straining causes a sudden rise in blood pressure, which adds strain on the heart; it increases the pressure in the lungs, which can affect blood flow from the body into the lungs; and it often means there’s more force on the chest wall, and many congenital heart patients have surgical scars in the chest that can be damaged, particularly in the first year after surgery.

Intensely physical sports such as football, boxing or hockey may increase the chance for injury and unnecessary strain on the cardiovascular system.

Any amount of activity is better than none, and the more physically active a person is, the greater the anticipated cardiovascular benefit. Guidelines for the general population suggest at least 30 minutes of dedicated aerobic activity a day for five or more days a week. This is a good target for congenital heart patients too. If it seems like too much, start with a more modest goal and build from there.

Lifestyle and home remedies

You’ll have regular follow-up appointments with your doctor to monitor your condition. You’ll need to continue taking all your medications as prescribed.

Your doctor may suggest you incorporate several heart-healthy lifestyle changes into your life, including:

• Eating 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.
• Maintaining a healthy weight. Aim to keep a healthy weight. If you’re overweight or obese, your doctor may recommend that you lose weight.
• Getting regular physical activity. Aim to include about 30 minutes of physical activity, such as brisk walks, into your daily fitness routine.
• Managing stress. Find ways to help manage your stress, such as through relaxation activities, meditation, physical activity, and spending time with family and friends.
• Avoiding tobacco. If you smoke, quit. Ask your doctor about resources to help you quit smoking. Joining a support group may be helpful.

For women with aortic valve stenosis, it’s important to talk with your doctor before you become pregnant. Your doctor can discuss with you which medications you can safely take, and whether you may need a procedure to treat your valve condition prior to pregnancy.

You’ll likely require close monitoring by your doctor during pregnancy. Doctors may recommend that women with severe valve stenosis avoid pregnancy to avoid the risk of complications.

Pregnancy

The risk from pregnancy depends on how severely the valve is obstructed or how much it’s leaking.

If you have mild or moderate stenosis and your left heart muscle (ventricle) is functioning normally, you can have a safe pregnancy, but you need medical supervision throughout the pregnancy. Sometimes balloon valvuloplasty can be done to relieve symptoms if they occur during pregnancy but only when symptoms can’t be controlled by medication and bed rest.

If your stenosis is severe and you have symptoms, avoid conception until you’ve had your heart valve repaired or replaced. If you’re considering pregnancy and you have aortic valve stenosis, you should meet with a multidisciplinary medical team that can give you more information about the risk of pregnancy to you and your baby.

Pregnancy in aortic regurgitation is better tolerated, but if the regurgitation has weakened the heart muscle and signs of heart failure are present before pregnancy, the risk posed by pregnancy is higher.

In patients who have had their heart valve replaced with a metal (mechanical) heart valve, they may be taking warfarin (Coumadin) which can cause risk to the fetus and alternative means of blood thinning may be required. In aortic insufficiency, women may be taking medicines such as ACE inhibitors such as lisinopril (Zestril) or enalapril (Vasotec). These drugs are dangerous to the developing fetus (see the section on Pregnancy) and need to be changed before conception.

It’s best to talk with your doctor before you plan to become pregnant.

1. American Heart Association. About Arrhythmia. http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/About-Arrhythmia_UCM_002010_Article.jsp[↩]
2. Centers for Disease Control and Prevention. Division of Birth Defects and Developmental Disabilities. Congenital Heart Defects (CHDs). https://www.cdc.gov/ncbddd/heartdefects/index.html[↩]
3. Congenital Heart Defects and Physical Activity. http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/CareTreatmentforCongenitalHeartDefects/Congenital-Heart-Defects-and-Physical-Activity_UCM_307738_Article.jsp[↩]