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Aortic Valve Disease

The aortic valve is a vital part of the working of the heart and is often involved in heart defects in children. When discussing aortic valve problems, it is best to first understand heart valves in general, to understand how a defect in the aortic valve can affect the heart.

Heart Valves

Heart valves keep blood flowing in one direction. The normal heart has four valves:

  • Right Side
    • Tricuspid valve - leading into right ventricle
    • Pulmonary valve - going out of right ventricle
  • Left Side
    • Mitral valve - leading into left ventricle
    • Aortic valve - going out of left ventricle

The hearts valves going into the ventricles keep blood that the ventricle pumps from going back to the atrium. The heart valves at the outlet of the ventricles keep the blood from going back into the ventricle in between beats. The valves work together to keep the blood going in the correct direction.

Aortic Valve Defects

Aortic stenosis is when the aortic valve does not let the blood, going the correct direction, pass through easily (an obstructed aortic valve). In this case, the left ventricle has to work harder to pump the blood past the obstructed valve into the aorta.

Aortic insufficiency is when the valve doesn't close properly (a "leaky" aortic valve), causing the left ventricle to repump the blood that had been pumped into the aorta but traveled backward into the ventricle.

Some valve defects have a component of both, where an immobile valve partially obstructs the flow out of the heart, but also doesn't close properly, so it also leaks.

In either kind of defect, there is extra work for the left ventricle. For aortic stenosis, it is extra "pressure" work (generating more pressure within the cavity of the ventricle to push the blood past the obstruction). For aortic insufficiency, it is extra "volume" work (repumping the blood that has come back from the aorta). If overstressed, the ventricle can slowly fail over time, thus, it is important to correct the aortic valve defect if the ventricle is sufficiently affected.

Aortic Valve Surgery

Aortic valves can occasionally be repaired, although this is uncommon. Young children with aortic stenosis can have their valves opened, either by a balloon procedure or by open surgery; however, this may not always be performed successfully. Older children and young adults can rarely have aortic stenosis repaired surgically. Even less commonly, aortic insufficiency can be repaired surgically. Thus, most people who have significant aortic valve problems require aortic valve replacement.

There are two types of replacement valves - each comes with its own set of advantages and disadvantages. In the table below, the term anticoagulation refers to the need to take "anticlotting" medications It is imperative that patients maintain careful follow-up so the amount of medication they receive is correct, and sometimes their lifestyle needs to be modified.

Valve Type

Advantage

Disadvantage

Mechanical

Lasts forever

Straightforward to implant

Needs anticoagulation

Does not grow

Tissue Valve

Straightforward to implant

Does not need anticoagulation

Limited longevity

Does not grow

Homograft (human cadaver valve)

Does not need anticoagulation

Limited longevity

Does not grow

Complex to implant

Ross Procedure (autograft)

Does not need anticoagulation

May last for decades

Complex to implant

Still may require future operations

The right valve choice for you

Some patients may choose a mechanical valve because it gives him/her the least chance of ever needing another heart surgery, but it does require anticoagulation. Other patients may prefer a tissue valve to avoid anticoagulation, knowing it will mean further heart surgery. Your surgeon will discuss with you and your family all of your options and help make the correct choice.

Contact Us

Pediatric Cardiology Clinic
University of Texas Health Science Center Professional Building
6410 Fannin, Suite 500
Houston, TX 77030

Phone: (832) 325-6516

Pediatric Cardiovascular Surgery Clinic
University of Texas Health Science Center Professional Building
6410 Fannin, Suite 950
Houston, TX 77030

Phone: (713) 500-7339

Contact us »

Note: This page is meant to be a helpful, informative introduction on the subject of aortic valve disease. The information may not be applicable to all cases, especially if there are additional defects. It is not meant to replace the opinion of a personal physician.