16745 Aortic Valve Surgery

Overview

Your heart has four valves. They work like one-way doors, opening and closing to keep blood flowing in the right direction. The aortic valve is the door blood passes through as it leaves your heart to travel around your body. Sometimes this valve stops working properly. It may become narrow and stiff, so blood struggles to get through (doctors call this aortic stenosis). Or it may not close tightly, so blood leaks backwards (called aortic regurgitation). When the valve problem becomes serious, an operation to repair or replace the valve can help your heart work properly again. This operation is called aortic valve surgery.

Yes. Problems with the aortic valve are among the most common heart valve conditions, and aortic valve surgery is a routine operation performed in hospitals all over the world every day. Heart teams have a lot of experience with it.

It most often affects older adults, because the valve can become thickened and stiff with age. It can also affect younger people, especially those born with an abnormal valve shape (called a bicuspid valve, where the valve has two flaps instead of three), people who had rheumatic fever in childhood, or people who have had chest radiotherapy or certain heart infections.

Symptoms

Common symptoms

• Feeling short of breath when you walk, climb stairs or do everyday tasks
• Chest pain or tightness, often brought on by activity
• Feeling dizzy, light-headed, or fainting
• Unusual tiredness or lack of energy
• Awareness of your heartbeat (palpitations) or a fluttering feeling
• Swollen ankles or feet, or putting on weight quickly from fluid build-up
• A heart murmur — an extra sound your doctor hears through a stethoscope, often found before any symptoms appear

Symptoms in children

• Many children with a valve problem have no symptoms at all and are found because a doctor hears a murmur
• Tiredness or getting out of breath more quickly than other children during play or sport
• Poor feeding or slow weight gain in babies
• Sometimes dizziness or fainting during exertion

Symptoms in older adults

• Breathlessness doing simple things like dressing, making a cup of tea or walking to the shops
• Becoming more slow or frail, or tiring easily
• Dizziness or falls
• Swelling in the legs and ankles, or waking at night short of breath
• Sometimes confusion or memory changes, which can be linked to the heart not pumping well

Causes

Main causes

• Age-related wear — calcium builds up and the valve becomes thick, stiff and narrow
• Being born with an abnormal valve, such as a bicuspid aortic valve
• Rheumatic fever in childhood, which can damage valves years later
• Previous chest radiotherapy or certain heart infections
• In some cases, a stretched or enlarged aorta (the large blood vessel above the valve) pulls the valve open so it cannot close properly

Risk factors

• Getting older — the chance rises steadily after age 60
• High blood pressure over many years
• High cholesterol and narrowed arteries (atherosclerosis)
• Smoking
• Diabetes and kidney disease
• A family history of heart valve problems or an enlarged aorta
• Untreated streptococcal throat infections in childhood (which can lead to rheumatic fever)

When to see a doctor

See a doctor urgently if:

• You faint or nearly faint, particularly during activity
• You develop chest pain or tightness with exertion
• You become much more breathless than usual, or breathless at rest
• Your ankles or legs swell up quickly, or your weight jumps up over a few days
• You have a fever and feel unwell and you have a known valve problem

Book a routine appointment if:

• You feel more tired or short of breath than you used to during everyday activities
• You have palpitations, even if they come and go
• You have been told you have a heart murmur
• You have a family history of valve problems or an enlarged aorta
• You are due a check-up for a known valve condition

Diagnosis

Your doctor will start by asking about your symptoms, listening to your heart with a stethoscope, and checking your blood pressure and pulse. If they suspect a valve problem, they will arrange tests — most importantly an echocardiogram, which is a painless ultrasound scan of the heart that shows how well the valve opens and closes. Once a valve problem is found, the tests help your heart team work out how serious it is, whether you need surgery, and which type of operation would suit you best.

Tests that may be done

• Echocardiogram (an ultrasound scan of the heart) — the main test for looking at the valve
• Electrocardiogram (ECG) — a quick recording of your heart's electrical rhythm
• Chest X-ray to look at the size and shape of your heart and lungs
• Blood tests to check your general health and how well your heart and kidneys are working
• Exercise test or a stress echo, to see how your heart copes when you are active
• CT scan or cardiac catheterisation (a thin tube passed into the heart) to look at the heart, valves and arteries in more detail before surgery

What to expect at your appointment

Most tests are quick and painless. An echocardiogram involves lying still while a technician moves a small probe over your chest with some gel — you may hear whooshing sounds, which is normal. You may have several appointments, and your case will usually be discussed by a team of heart specialists, including surgeons and cardiologists, who together recommend the best option for you. Bring someone with you if it helps, and write down your questions beforehand.

Treatment

Treatment depends on how serious the valve problem is, whether you have symptoms, and your general health. Some people are simply monitored with regular check-ups and scans. Others need medicines to ease symptoms such as fluid build-up. When the valve problem starts to put strain on your heart, an operation to repair or replace the valve is usually the best way to protect your heart and improve how you feel.

Self-care at home

• Stop smoking if you smoke — ask your GP or pharmacist for support
• Keep to a healthy weight and stay as active as your heart team advises
• Take any prescribed medicines regularly and ask your pharmacist if you are unsure about them
• Look after your teeth and gums and have regular dental check-ups — tell your dentist about your valve problem
• Avoid people with infections where you can, and get any fever checked if you feel unwell
• Attend all your follow-up appointments and scans, even if you feel fine

Medical treatments

Medicines cannot fix a damaged valve, but they can help control symptoms and protect your heart in the meantime. These may include tablets to lower blood pressure, tablets that help your body get rid of extra fluid, and medicines to control your heart rhythm. Your doctor will explain what each medicine is for and review it regularly. The only way to fix the valve itself is an operation or procedure. There are two main approaches: repairing your own valve, or replacing it with an artificial valve. Replacement valves are either mechanical (made of man-made materials) or biological (made from animal tissue or donated human tissue). A less invasive option, TAVI, places a new valve through a blood vessel, usually in the leg, without opening the chest — it is often used for people who are older or frailer. Your heart team will talk you through the pros and cons of each option.

When is surgery considered?

Surgery is usually recommended when the valve problem starts to cause symptoms, or when tests show your heart is being strained even if you feel well. If you have severe narrowing of the valve, doctors often advise an operation before the heart muscle is damaged, because results are better when done at the right time. In an emergency — for example if the valve suddenly fails or you become very unwell — surgery may be needed urgently. Your heart team will explain why they think an operation is right for you, and what happens if you choose to wait.

Living with this condition

After surgery, you will spend some time in hospital and then recover gradually at home. If you had open-heart surgery, your breastbone (sternum) needs about 6 to 12 weeks to heal, so you will be asked to avoid heavy lifting, pushing and pulling for a while. Many people feel tired at first and improve slowly. Most people can drive again after a few weeks, once they feel able and their doctor agrees, and can return to work depending on their job and how they recover. Gentle, regular walking is encouraged early on. If you had a mechanical valve, you will need to take a blood-thinning medicine long term and have regular blood tests to keep it safe — your team will explain this fully.

Lifestyle tips

• Build activity up gradually, following your cardiac rehabilitation team's advice
• Keep to a heart-healthy diet and watch your weight
• Stay smoke-free — support is available and free in most places
• Keep alcohol within recommended limits
• Take care of your teeth, and mention your valve to your dentist
• Tell any doctor, nurse or dentist treating you that you have a heart valve repair or replacement
• Carry your valve details or alert card if you are given one

Diet and exercise

Eat a varied, balanced diet with plenty of vegetables, fruit, wholegrains, beans and fish, and go easy on salt, sugary foods and highly processed foods. Limiting salt helps with fluid build-up. After surgery, cardiac rehabilitation — a supervised programme of gentle exercise and advice — is one of the best things you can do for your recovery. It is safe, it is tailored to you, and it helps you get stronger and feel more confident. Ask your hospital team how to join.

Mental health and emotional wellbeing

It is very common to feel anxious before heart surgery and low or tearful afterwards. Many people worry about their heart, about recovering, or about getting back to normal life. These feelings usually ease with time and support, but they are worth talking about — with your GP, your heart team, or a counsellor. If you ever feel unable to cope or have thoughts of harming yourself, please reach out for help straight away: contact your local emergency number or a crisis support service in your country, or speak to a doctor you trust.

Prevention

Not all valve problems can be prevented, especially those you are born with or that come with getting older. But you can lower your risk of heart and blood vessel disease, which helps protect your valves and your heart as a whole. That means keeping your blood pressure and cholesterol in a healthy range, not smoking, staying active, eating well and keeping to a healthy weight. Prompt treatment of strep throat infections also helps prevent rheumatic heart disease. If you have a known valve problem or an enlarged aorta, regular check-ups help make sure any change is picked up early.

Vaccines

People with heart conditions are usually advised to have a yearly flu vaccine and to keep up to date with recommended vaccinations, such as pneumonia and COVID-19 vaccines. Ask your GP, nurse or pharmacist which vaccines are advised for you.

Screening programmes

There is no routine national screening programme for valve problems. However, if a doctor hears a heart murmur, or if you have a strong family history of valve disease or an enlarged aorta, an echocardiogram may be arranged. Speak to your GP if you are concerned about your family history.

Complications

If left untreated

• The heart muscle can become weak and stretched, leading to heart failure — breathlessness, tiredness and fluid build-up
• Irregular heart rhythms, such as atrial fibrillation
• Infections of the valve, which can be serious
• Fainting or sudden collapse, which is a warning sign that needs urgent attention
• In severe untreated narrowing of the valve, there is a risk of sudden death, which is why doctors recommend surgery at the right time

Long-term outlook

The outlook after aortic valve surgery is generally good, and most people notice a real improvement in breathlessness, energy and quality of life. Recovery takes weeks rather than days, and it is normal to have good and bad days along the way. Replacement valves can last many years — biological valves may need replacing eventually, while mechanical valves are very long lasting but need blood-thinning medicine. Your heart team will keep checking you with regular scans. Many people go back to work, travel, exercise and enjoy life much as before.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.