What happens to the valve
The tricuspid valve opens and closes evenly, distributing the load across the three leaflets. When there are two valves, each of them experiences increased mechanical stress with each contraction. The tissue of the valves gradually becomes denser, calcium is deposited in it, and mobility decreases. As a result, the hole narrows - aortic stenosis forms, or the valves stop closing tightly and part of the blood returns to the ventricle - aortic insufficiency develops. Often there is a combination of both disorders, and with them dilatation of the aorta.
- Long asymptomatic period
- Gradual compaction and calcification of the valves
- Aortic stenosis - narrowing of the outlet of the ventricle
- Aortic insufficiency - reverse blood flow
- Dilatation of the ascending aorta - aortopathy
- Increased risk of infective endocarditis
Causes and risk factors
The defect is formed in the prenatal period, when the leaflets of the aortic valve are not completely separated. The exact cause is unknown, but there is a hereditary predisposition: in close relatives, such a valve is much more common, so they are recommended to undergo a single echocardiography. Men encounter vice more often than women. The rate at which complications develop depends not only on the valve itself, but also on how well blood pressure, lipids, and bad habits are controlled.
- Violation of valve formation in the fetus
- Family predisposition
- Male gender
- Arterial hypertension
- Smoking and high cholesterol
- Combination with coarctation of the aorta and other defects
Symptoms
As long as the valve copes with the load, there are no complaints, and the defect is detected by a heart murmur during examination or by chance on an ultrasound. Symptoms appear when the narrowing becomes severe or the backflow of blood is significant. The classic triad for stenosis is angina, syncope on exertion, and shortness of breath. With valve insufficiency, the most common symptoms are the feeling of strong heartbeats, fatigue and shortness of breath when lying down. It is important that the appearance of complaints is already a signal to discuss the operation.
- Heart murmur on auscultation
- Shortness of breath on exertion and then at rest
- Chest pain during exercise
- Dizziness and fainting during exercise
- Fatigue and decreased endurance
- Feeling of increased heart rate
Diagnosis and observation
The main method is echocardiography: it shows the number of leaflets, the degree of calcification, the orifice area, the pressure gradient, the volume of reverse flow and the diameter of the ascending aorta. Using these data, the doctor determines how often the test needs to be repeated - usually from once a year to once every few years. If the aorta is poorly visible on ultrasound or is already dilated, a CT or MRI is prescribed. An ECG helps assess left ventricular overload, and stress tests are used in patients without complaints to clarify load tolerance.
- EchoCG as the main and repeated method
- Measuring the diameter of the ascending aorta
- ECG, signs of left ventricular hypertrophy
- CT or MRI of the aorta during dilatation
- Screening echocardiography for close relatives
- Blood pressure control
Treatment and prevention of complications
There are no drugs that restore the valves or stop calcification. Treatment is aimed at protecting the valve and aorta: normalizing blood pressure, correcting lipids, quitting smoking. In case of severe stenosis, significant insufficiency or significant expansion of the aorta, an operation is performed - valve replacement with a mechanical or biological prosthesis, reconstructive plastic surgery, and in the case of aortopathy, at the same time, intervention on the aorta. Prevention of infective endocarditis is important: timely dental treatment and mandatory mention of the defect before any interventions.
- Blood pressure and lipid control
- Quitting smoking
- Dental sanitation and endocarditis prevention
- Limiting static loads and heavy lifting as recommended by a doctor
- Valve replacement or repair according to indications
- Intervention on the ascending aorta for aneurysm
