Figure 1. Aortic stenosis prevents the valve from opening fully, while aortic regurgitation prevents it from closing properly, allowing blood to leak backwards. Image credit: Heart Foundation NZ.
What Is Aortic Valve Disease?
The aortic valve sits between the heart’s main pumping chamber, known as the left ventricle, and the aorta – the major artery that carries oxygen-rich blood around the body. With each heartbeat, the valve opens to let blood flow out and then closes to prevent it from moving backwards.
Aortic valve disease can affect this function in two main ways:
- Aortic stenosis: The valve becomes thickened, stiff or calcified and cannot open fully, restricting blood flow out of the heart.
- Aortic regurgitation: The valve does not close tightly, allowing some blood to leak backwards into the heart.
Both conditions place extra strain on the left ventricle. Over time, severe valve disease may enlarge or weaken the heart and lead to heart failure.
What Causes Aortic Stenosis and Regurgitation?
Aortic stenosis is most commonly caused by age-related calcium build-up. It may also occur earlier in people born with a bicuspid aortic valve, which has two leaflets instead of three, or develop following rheumatic heart disease.
Aortic regurgitation may result from abnormalities of the valve itself or enlargement of the aortic root. Possible causes include a bicuspid valve, age-related changes, infection of the heart valve, rheumatic disease and conditions affecting the aorta. In rare cases, a sudden tear in the aorta or valve infection can cause acute, severe leakage that requires urgent treatment.
What Are the Symptoms?
Mild or moderate aortic valve disease may not cause noticeable symptoms. As either condition progresses, patients may experience:
- Shortness of breath, particularly during activity
- Chest pain, pressure or tightness
- Fatigue or reduced exercise capacity
- Dizziness, light-headedness or fainting
- Palpitations
- Swelling of the ankles or legs
Some people gradually reduce their activity without realising their stamina has declined. New chest pain, fainting or severe breathlessness should be assessed urgently.
How Is Aortic Valve Disease Diagnosed?
A doctor may first suspect valve disease after hearing a heart murmur. An echocardiogram is the main test used to assess the valve, measure blood flow and determine how the heart is responding.
Depending on the findings, additional tests may include an electrocardiogram (ECG), exercise testing, CT imaging, cardiac magnetic resonance imaging or cardiac catheterisation. Regular follow-up is important because the condition may progress even when symptoms are mild or absent.
What Are the Treatment Options?
Treatment depends on the type and severity of valve disease, the presence of symptoms and whether the heart is beginning to enlarge or weaken.
Monitoring and Medication
Mild or moderate disease may only require regular reviews and repeat imaging. Medicines may help manage high blood pressure, fluid retention, heart rhythm problems or heart failure symptoms. However, they cannot open a narrowed valve or permanently stop a valve from leaking.
Valve Replacement for Aortic Stenosis
Severe aortic stenosis is generally treated by replacing the valve. Surgical aortic valve replacement removes the diseased valve and replaces it with a mechanical or tissue valve.
For suitable patients, transcatheter aortic valve implantation (TAVI), also called TAVR, offers a less invasive alternative. A tissue valve is delivered through a catheter, usually via an artery in the groin, and expanded inside the narrowed valve.
The choice between TAVI and surgery depends on factors such as age, anatomy, overall health, other heart conditions and the potential need for future procedures.
Surgery for Aortic Regurgitation
When severe aortic regurgitation causes symptoms or affects the heart, surgery is usually the standard treatment. The valve may be repaired in selected patients or replaced with a mechanical or tissue valve. If the aortic root or ascending aorta is enlarged, it may also need repair or replacement.
TAVI is well established for aortic stenosis but is not routinely used for native aortic regurgitation. It may be considered for selected patients with severe regurgitation who are at elevated risk for surgery and have appropriate anatomy.
Recently, our clinic has used the newly launched JenaValve Trilogy System to treat patients with pure severe native aortic regurgitation. This is a purpose built TAVI valve specifically designed for treating patients with pure aortic regurgitation. The JenaValve has been shown to be safer and to result in better clinical outcomes when used for patients with pure aortic regurgitation as compared to using other TAVI valves that are used for patients with aortic stenosis.
Speak to a Heart Specialist
Aortic stenosis and aortic regurgitation affect blood flow in different ways, but both can worsen over time. A heart specialist can determine the type and severity of valve disease, monitor its effects on the heart and recommend the most suitable timing and form of treatment.
Contact The Heart & Vascular Centre to learn more about aortic valve disease and discuss the treatment options that may be appropriate for you.
References:
- 2025 ESC/EACTS Guidelines for the management of valvular heart disease. (2025). European Society of Cardiology. https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/valvular-heart-disease/
- Aortic Valve Regurgitation. (n.d.). American Heart Association. https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/problem-aortic-valve-regurgitation
- Managing Aortic Stenosis Symptoms. (2026). American Heart Association. https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-disease-risks-signs-and-symptoms/managing-aortic-stenosis-symptom
- Medications for Heart Valve Disease Symptoms. (2026). American Heart Association. https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/understanding-your-heart-valve-treatment-options/medications-for-heart-valve-symptoms
