Aortic Stenosis

What is aortic valve stenosis? 

Aortic valve stenosis, also called aortic stenosis, is a heart condition in which the aortic valve becomes narrow and does not open fully. The aortic valve controls blood flow from the heart’s main pumping chamber, called the left ventricle, into the aorta and out to the rest of the body. 

When the valve opening becomes too small, the heart must work harder to push blood through. Over time, this strain can damage the heart and lead to heart failure if the condition is not treated. 

How aortic stenosis affects blood flow and the heart 

In a healthy heart, the aortic valve opens wide with each heartbeat. With aortic valve stenosis, the valve cannot open fully, which limits blood flow. 

As a result: 

• Pressure builds up in the left ventricle 
• The heart muscle thickens to compensate 
• The affected heart chamber becomes less efficient over time 

This reduced blood flow can cause symptoms and raise the risk of serious complications as the condition worsens. 

Causes of aortic valve stenosis 

Aortic valve stenosis occurs when the aortic valve becomes thickened, stiff or narrowed, limiting blood flow from the left ventricle to the body.  

Common causes include: 

• Age-related calcium buildup on the valve, which causes the leaflets to stiffen over time 
• Bicuspid aortic valve, a congenital condition in which the valve has two leaflets instead of three 
• Rheumatic fever, which can scar and damage the valve 
• Prior radiation therapy to the chest, which can cause long-term valve damage years after treatment 

These causes directly damage the valve and lead to narrowing that makes the heart work harder to pump blood. 

Risk factors for developing aortic stenosis 

Risk factors do not directly cause valve narrowing, but they increase the chance that a person will develop aortic stenosis or that the condition will worsen over time. 

Risk factors include: 

• Older age, especially over 65 
• Family history of heart valve disease or congenital heart conditions 
• Conditions that increase calcium buildup, such as chronic kidney disease 
• High blood pressure, which increases strain on the heart 
• High cholesterol levels 
• A history of infective endocarditis, which can damage heart valves 
• Previous heart surgery or structural heart disease 

Having one or more risk factors does not mean you will develop aortic stenosis, but it does raise your likelihood of developing this heart condition or experiencing faster progression. 

Signs and symptoms of aortic stenosis 

Aortic stenosis can exist for years without symptoms. As the valve narrows, symptoms often develop. 

Common symptoms include: 

• Shortness of breath, especially during activity 
• Chest pain or pressure 
• Fatigue or reduced ability to exercise 
• Dizziness or fainting 
• A heart murmur, which is an abnormal sound heard during a heart exam 

These symptoms occur because the heart cannot pump enough blood to meet the body’s needs. 

Stages and severity of aortic stenosis 

Aortic valve stenosis is usually described as mild, moderate or severe. 

Mild aortic stenosis 

Blood flow is only slightly reduced. Most people have no symptoms and need regular monitoring. 

Moderate aortic stenosis 

Blood flow is more limited. Symptoms may begin during physical activity. 

Severe aortic stenosis 

Blood flow is significantly restricted. Symptoms are common, and without treatment, the condition can lead to heart failure or other serious complications. 

What happens if aortic stenosis is not treated? 

As aortic stenosis progresses, the heart must continue to pump against increased resistance. Over time, this can: 

• Weaken the left ventricle 
• Reduce blood flow to the body 
• Increase the risk of heart rhythm problems 
• Lead to heart failure or sudden cardiac events 

Early diagnosis and proper treatment help protect heart function. 

How aortic valve stenosis is diagnosed 

Doctors may first detect aortic stenosis by hearing a heart murmur during a physical exam. Tests used to confirm and monitor the condition include: 

• Echocardiogram to measure valve narrowing and blood flow 
• Imaging tests to assess valve structure and heart chamber function 
• Regular follow-up testing to track disease progression 

Treatment options for aortic valve stenosis 

Treatment depends on how severe the valve narrowing is and whether symptoms are present. Mild cases may only need monitoring, while more advanced disease often requires valve replacement. 

There is no medication that can fix a narrowed aortic valve. When symptoms develop or the valve becomes severely narrowed, valve replacement is the most effective treatment.

Monitoring and medical management 

People with mild or moderate aortic stenosis may not need immediate intervention. Instead, care focuses on: 

• Routine echocardiograms 
• Monitoring for new or worsening symptoms 
• Managing related heart conditions 

Because aortic stenosis often worsens over time, ongoing follow-up is important even when symptoms are mild or absent. 

When valve replacement is recommended 

Valve replacement is typically recommended when: 

• Symptoms such as shortness of breath or chest pain appear 
• The valve becomes severely narrowed 
• The left ventricle shows signs of strain or weakening 
• Blood flow from the heart is significantly reduced 

Replacing the valve improves blood flow and lowers the risk of heart failure. 

Aortic valve replacement options 

There are two main approaches to aortic valve replacement. The best option depends on age, overall health, valve anatomy and personal goals. 

Surgical aortic valve replacement (SAVR) 

Surgical aortic valve replacement (SAVR) is a traditional open-heart surgery. The damaged valve is removed and replaced with a new valve. 

Key points about SAVR: 

• Requires open-heart surgery 
• Often recommended for younger or lower-risk patients 
• Offers long-term durability 
• Recovery usually takes several weeks 

SAVR has a long track record and remains an important treatment option. 

Transcatheter aortic valve replacement (TAVR) 

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that replaces the valve without open-heart surgery. A catheter is used to place the new valve, most often through a blood vessel in the leg. 

Key points about TAVR: 

• No open-heart surgery 
• Shorter hospital stay and faster recovery 
• Often used for older adults or people at higher surgical risk 
• Now approved for many lower-risk patients 

TAVR has become a widely used and effective treatment for aortic valve stenosis. 

Choosing between SAVR and TAVR 

The decision between SAVR and TAVR is made by a specialized heart team and considers: 

• Age and overall health 
• Severity of aortic stenosis 
• Valve and blood vessel anatomy 
• Other medical conditions 
• Lifestyle and long-term needs 

Both options improve blood flow, reduce strain on the heart and lower the risk that aortic stenosis will lead to heart failure. 

Life after valve replacement 

Most people notice meaningful improvement after valve replacement, including: 

• Better breathing 
• Less chest pain 
• Improved energy and activity tolerance 

Ongoing care may include cardiac rehabilitation, follow-up imaging and regular heart checkups. 

How to lower your risk of aortic valve stenosis 

Aortic valve stenosis cannot always be prevented, especially when it is related to aging or a congenital valve condition. However, certain steps may help lower your risk or slow progression by protecting overall heart health: 

• Stop smoking and vaping, which can damage blood vessels and increase strain on the heart 
• Maintain a low-cholesterol diet to help reduce plaque and calcium buildup that can affect heart valves over time 
• Prevent and treat high blood pressure, since elevated blood pressure forces the heart to work harder and increases stress on the aortic valve 
• Treat infections promptly and complete antibiotic prescriptions as directed, which helps reduce the risk of heart damage from bacterial infections such as rheumatic fever or infective endocarditis 
• Manage chronic conditions, such as kidney disease or diabetes, that can affect heart and valve health 
• Keep regular heart checkups, especially if you have a heart murmur, prior radiation therapy to the chest or a family history of valve disease 

These steps cannot reverse aortic valve stenosis, but they can support heart health, reduce complications and help identify changes early. 

When to see a heart specialist 

If you have symptoms such as chest pain, shortness of breath, fainting or a newly detected heart murmur, see a cardiologist. Early evaluation helps determine the right timing and treatment approach. 

At Banner Health, heart specialists provide comprehensive valve care, including both SAVR and TAVR, tailored to each patient’s needs.