Aortic Valve Replacement

What is the Aortic Valve

The aortic valve is one of the valves of the heart. It lies between the left ventricle and the aorta. First we will discuss the aortic valve then aortic valve replacement surgery.

Aortic Valve Morphology (Shape)

The aortic valve has three cusps. These cusps are half moon shaped hence also called aortic semilunar valve. Each cusp has a small swelling in the center called the nodule. Dilatation of the wall of the aorta opposite these cusps is called aortic sinus. When the aortic valve is open, the normal size of the orifice is 3-4 cm².

Aortic Valve Function and Physiology

During ventricular systole, pressure rises in the left ventricle. When the pressure in the left ventricle rises above the pressure in the aorta, the aortic valve opens, allowing blood to exit the left ventricle into the aorta. When ventricular systole ends, pressure in the left ventricle rapidly drops. When the pressure in the left ventricle decreases, the aortic pressure forces the aortic valve to close. The aortic sinuses help in closure of the valve by creating backflow eddies. The closure of the aortic valve contributes the A₂ component of the second heart sound (S₂).

Aortic Valve Disease

There are a number of diseases that can affect the aortic valve.

• Common diseases that cause the aortic valve to be stenotic (not open fully) include rheumatic fever, degenerative calcification, and congenital diseases such as bicuspid aortic valve.
• Common causes of regurgitation or leakage of the aortic valve include dilation of the aorta, myxomatous degeneration of the aortic valve, and Marfan’s syndrome.

Bicuspid Aortic Valve

The most common congenital abnormality of the heart is the bicuspid aortic valve. In this condition, instead of three cusps, the aortic valve has two cusps. This condition is often undiagnosed until later in life when the person develops symptomatic aortic stenosis. Aortic stenosis occurs in this condition usually in patients in their 40s or 50s, an average of 10 years earlier than can occur in people with congenitally normal aortic valves.

Aortic Valve Replacement

Aortic valve replacement means that a patient’s aortic valve is replaced by a different valve. The aortic valve can be affected by a range of diseases and require aortic valve replacement. The valve can either become leaky (regurgitant or insufficient) or stuck partially shut (stenotic). Aortic valve replacement currently requires open heart surgery. Research is being done now on to develop valves that can be implanted using a catheter without open heart surgery. There are two basic types of artificial heart valve, mechanical valves and tissue valves. Tissue heart valves are usually made from animal tissues, either animal heart valve tissue or animal pericardial tissue. The tissue is treated to prevent rejection and to prevent calcification.

There are alternatives to animal tissue valves. In some cases a human aortic valve can be implanted. These are called homografts. Homograft valves are donated by patients and harvested after the patient expires. The durability of homograft valves is probably the same for porcine tissue valves.

Another procedure for aortic valve replacement is the Ross procedure or pulmonary autograft. The Ross procedure involves going to surgery to have the aortic valve removed and replacing it with the patient's own pulmonary valve. A pulmonary homograft (a pulmonary valve taken from a cadaver) is then used to replace the patients own pulmonary valve.