The aortic valve is the heart valve located between the left ventricle and aorta, which is the blood vessel that delivers newly oxygenated blood to the entire body. Like the tricuspid valve, the aortic valve is comprised of three flaps called cusps.

Two diseases can affect the aortic valve. The first is aortic stenosis, which occurs when the aortic valve stiffens, narrows and obstructs blood from flowing from the left ventricle to the aorta. The most common type is a degenerative (wear and tear) condition that most commonly occurs when patients are in their seventies and eighties. Another type is the congenitally (meaning the patient is born with it) abnormal valve that's characterized by two cusps instead of the normal three. During the patient's fifties and sixties, this valve wears down and can cause stenosis and ironically can also cause a leaking valve. Depending upon the extent of the condition, pressure may increase in the left ventricle and blood may not be effectively pumped to the body normally. Excessive strain on the muscle of the main pumping chamber (left ventricle) develops over time. Symptoms develop because of inadequate blood flow to the vital organs of the body.

The second condition is called aortic regurgitation (or aortic insufficiency). The aortic valve doesn't close correctly, which causes blood to leak back into the left ventricle. Prognosis for both of these conditions depends upon the severity of the condition and the illness that causes it to develop.

The two primary causes of aortic valve disease are:

• Congenital defect
• Degenerative calcification of the aortic valve (generally caused by increasing age)

Aortic regurgitation and aortic stenosis may not cause symptoms, but when the condition becomes severe, patients may experience:

• Chest palpitations
• Shortness of breath (especially during or after physical activity)
• Light headed feeling, dizziness, fainting
• Chest pain, palpitations
• Arrhythmia, fast heartbeat

Your physician may suspect aortic valve disease after listening to your heart with a stethoscope and conducting a thorough physical exam. If you physician suspects aortic valve stenosis or regurgitation, he or she may order one or more of the following tests:

• Echocardiogram
• EKG
• Chest X-ray
• Transesophageal echocardiogram (TEE)
• Diagnostic cardiac catheterization
• MRI

Treatment for both aortic stenosis and insufficiency may include:

• Endocarditis prevention, including preventive antibiotics before dental work and medical procedures
• Drug therapy to treat heart arrhythmias and heart failure, which are sometimes complications of this condition (diuretics, vasodilators, beta blockers, digoxin, nitrates, antiarrhythmia, anticoagulants)
• Physical activity restrictions
• Surgical repair or replacement of the valve
• Valvuloplasty (cardiac catheterization therapy opens the heart valve)

Aside from endocarditis prevention, including preventive antibiotics prior to dental procedures, patients with mild or absent symptoms may experience few complications and require no therapeutic treatment. If you're diagnosed with this condition, inform all of your physicians and dentist of your diagnosis. Your primary care physician and/or cardiologist will want to monitor your condition closely. Be sure to follow-up regularly and obtain all recommended tests. Your treatment may also encompass therapy for complications that can occur with aortic valve disease, such as atrial fibrillation, pulmonary emboli, stroke, heart failure, etc.

In the case of aortic stenosis, in particular, surgery is often required. In fact, aortic stenosis is the most common reason heart valve surgery is performed on adults. Symptomatic patients with aortic regurgitation may also require surgery to repair or replace the heart valve. Today aortic valve replacement surgery is associated with excellent long-term results and acceptable surgical risks. Innovative modifications of the surgical procedure may one day lead to routine replacement of the valve through a limited incision approach. This assessment applies to repair and replacement of the mitral valve as well.