Aortic valve diseases

Frequent causes of aortic valve disease are congenital malformations, narrowing (stenosis) due to degenerative calcification or as a result of valve inflammation (endocarditis).

Inability to close (aortic insufficiency) is observed with a widening of the aortic root, for example, due to cystic medial necrosis or Marfan syndrome and also after endocarditis. Nowadays, primary bacterial inflammation especially of the aortic valve appears to be increasing again.

Multiple valvular defects are not uncommon, with the mitral and aortic valves mainly affected. In rare cases, the tricuspid valve is diseased in addition.

Symptoms

Surgery is indicated for patients who feel an impairment in their performance on even mild to moderate exertion on account of their heart valve defect. Advanced age in itself is not a contraindication for aortic valve replacement. In rare cases, severe comorbidities (e.g. pulmonary hypertension, severely impaired liver and/or kidney function) can be contraindications to a conventional operation. In these cases, transfemoral or transapical aortic valve replacement is an alternative.

Florid endocarditis (marked inflammation of the lining of the heart) should first be treated with effective antibiotics. If septic temperatures persist after one to two weeks or if the patient’s overall condition deteriorates because of a particularly serious change in the valve, septic emboli or similar problems, the decision on valvular surgery should be made immediately.

Diagnosis

Along with the physical examination, ECG and chest X-ray, making the diagnosis requires and ultrasound scan (echocardiography) with colour-coded Doppler in order to quantify the drop in blood pressure across the narrowed valve or the backflow of blood through a valve that no longer closes tightly. Cardiac catheterisation with coronary angiography should always be performed before the operation.