Aortic Valve Disease: Stenosis vs. Regurgitation — Symptoms, Causes & Treatment

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer: What Is Aortic Valve Disease?

Aortic valve disease is a heart valve disease in which the aortic valve does not work properly, either narrowing and limiting blood flow out of the heart (stenosis) or leaking backward (regurgitation) [1]. It may be congenital or develop from aging, infections or high blood pressure [1]. Treatment ranges from checkups and medicines to valve repair or replacement, including TAVR [2].

What the research says

• Age-related calcific aortic valve disease is common worldwide and growing. The Global Burden of Disease Study 2017 estimated 12.6 million people living with calcific aortic valve disease and 102,700 deaths from it in 2017, with the disease burden (disability-adjusted life-years) up 101% between 1990 and 2017. (Yadgir et al., Circulation, 2020) [3]

• A bicuspid valve did not speed up aortic widening after valve replacement. A 2026 meta-analysis of 15 studies found no significant difference in yearly aortic growth between bicuspid and tricuspid valves after valve replacement (mean difference 0.15 mm/year, 95% CI −0.03 to 0.33; 1,772 patients) and no significant difference in aortic dissection risk (risk ratio 1.34, 95% CI 0.63–2.83; 2,307 patients). (Fernandes Pedro et al., Rev Port Cardiol, 2026) [4]

• For TAVR in bicuspid stenosis, valve type changes the side-effect profile, not survival. Across 19 studies (3,794 participants), balloon-expandable and self-expanding valves had similar procedural, 1-year and 3-year mortality; balloon-expandable valves carried a lower risk of pacemaker implantation (odds ratio 0.60, 95% CI 0.48–0.76) but a higher risk of annular rupture (odds ratio 2.80, 95% CI 1.05–7.49). (Attachaipanich et al., J Cardiovasc Med, 2025) [5]

Aortic Valve Disease at a Glance

Feature	Summary
Definition	A heart valve disease in which the aortic valve between the lower left chamber and the aorta doesn't work properly [1]
Two forms	Stenosis (narrowed valve blocks blood flow) and regurgitation (leaky valve lets blood flow backward) [1]
Onset	Can be present at birth (congenital) or develop later in life [1]
Key symptoms	Chest pain or tightness, dizziness, fainting, fatigue after activity, irregular heartbeat, shortness of breath [1]
Causes	Congenital defects, age-related changes, infections, high blood pressure, heart injury [1]
Main risk factors	Older age, bicuspid valve, rheumatic fever, endocarditis, chest radiation history, chronic kidney disease, lupus, Marfan syndrome [1]
Complications	Blood clots, stroke, heart failure, arrhythmias, sudden cardiac arrest [1]
Staging	Stage A (at risk) → B (progressive) → C (severe, no symptoms) → D (severe with symptoms) [2]
Treatments	Checkups, lifestyle changes, medicines, valve repair, valve replacement (mechanical/biological/TAVR/Ross procedure) [2]

What Is Aortic Valve Disease?

Aortic valve disease is a type of heart valve disease. In this condition, the valve between the lower left heart chamber and the body's main artery doesn't work as it should [1].

To understand why that matters, picture the heart's plumbing. A typical heart has two upper chambers (the right and left atria) that receive incoming blood and two lower, more muscular chambers (the right and left ventricles) that pump blood out. Sitting at the chamber openings are four valves — aortic, mitral, tricuspid, and pulmonary — that act as gates to keep blood flowing in the right direction. Each valve has flaps, also called cusps or leaflets, that open and close once during each heartbeat [1].

The aortic valve sits between the lower left chamber (the left ventricle) and the aorta — the body's main artery. Its job is to keep blood flowing the right way through the heart. When the aortic valve is damaged or diseased, it affects blood flow to the rest of the heart and body.

What are the two forms of aortic valve disease?

Aortic valve disease takes two forms, stenosis and regurgitation, and in stenosis a narrowed valve slows blood flow and builds pressure inside the heart.

Form	What Goes Wrong	What It Does to Blood Flow
Aortic valve stenosis	The valve flaps become thick and stiff, or they connect (fuse) together, making the valve opening narrow [1]	The narrowed valve reduces or blocks blood flow from the heart to the rest of the body. The heart must work harder to push blood across the smaller opening, pressure builds up within the heart, and over time the strain reduces the heart's ability to pump [1]
Aortic valve regurgitation	The aortic valve doesn't close tightly [1]	Blood flows backward from the aorta into the lower left heart chamber (the left ventricle) [1]

A helpful way to picture stenosis: imagine placing smaller and smaller nozzles on the end of a garden hose. The narrower the nozzle, the slower the flow of water — and the more pressure builds up inside the hose. That is exactly what happens inside the heart when the aortic valve narrows [1].

Note the anatomy detail: the aortic valve typically has three cusps (a tricuspid aortic valve) [1]. But some people are born with an aortic valve that has two cusps — a condition called bicuspid aortic valve — and that raises the risk of valve disease later in life.

A person may be born with aortic valve disease (a congenital heart defect), or it can occur later in life due to other health conditions [1].

What are the eight warning signs of aortic valve disease?

Some people with aortic valve disease may not notice symptoms for many years [1]. When symptoms do appear, they may include:

• Chest pain or tightness

• Dizziness

• Fainting

• Feeling unusually tired after activity — or having less ability to be active [1]

• Irregular heartbeat

• Shortness of breath, particularly during vigorous activity or when lying down [1]

• Not eating enough (mainly seen in children with aortic valve stenosis) [1]

• Not gaining enough weight (mainly seen in children with aortic valve stenosis) [1]

When to See a Doctor

Treat the following as emergencies and action items, not waiting-room appointments:

• Sudden chest pain → Call 911 or your local emergency number [1].

• Symptoms such as shortness of breath, fatigue after activity, or a pounding or irregular heartbeat → make an appointment for a health checkup [1].

• Heart-failure warning signs → the first symptoms of aortic valve disease are sometimes related to heart failure. Get a checkup if you have fatigue that doesn't get better with rest, shortness of breath, and swollen ankles and feet [1].

What causes aortic valve disease and who is at risk?

Aortic valve disease may be caused by a heart defect present at birth or by later causes such as age-related heart changes, infections, high blood pressure and heart injury.

Causes

Aortic valve disease may be caused by a heart condition present at birth (a congenital heart defect) [1]. Other causes that develop later in life include:

• Age-related changes to the heart

• Infections

• High blood pressure

• Injury to the heart

Six Risk Factors

Risk Factor	How It Raises Risk
Older age	Calcium can build up on the aortic valve as people age, causing the valve to stiffen and become narrow [1]
A congenital heart defect	Some people are born with a missing, extra, or fused heart valve flap — increasing the risk of aortic valve regurgitation (bicuspid valve is the classic example) [1]
Rheumatic fever	A complication of strep throat that can cause aortic stenosis; valve disease from rheumatic fever is called rheumatic heart disease; otherwise, nonrheumatic heart disease [1]
Endocarditis	Inflammation of the lining of the heart's chambers and valves, usually caused by infection; a life-threatening condition that can damage the aortic valve [1]
History of chest radiation therapy	Some cancers are treated with radiation; valve disease symptoms may not be noticed until many years after treatment [1]
Other health conditions	Chronic kidney disease, lupus, and Marfan syndrome (a connective tissue disease) can increase the risk of stenosis or regurgitation [1]

Why does untreated aortic valve disease matter?

Untreated aortic valve disease may lead to blood clots, stroke, heart failure, arrhythmias and death from sudden cardiac arrest, though proper diagnosis and treatment can reduce these risks [1].

• Blood clots

• Stroke

• Heart failure

• Arrhythmias (irregular heartbeats)

• Death due to sudden cardiac arrest [1]

The good news: proper diagnosis and treatment can help reduce the risk of these complications [1].

How is aortic valve disease diagnosed?

To diagnose aortic valve disease, a healthcare professional examines you and asks questions about your symptoms and medical history. A whooshing sound called a heart murmur may be heard when listening to the heart with a stethoscope — if so, you may be referred to a cardiologist, a doctor trained in heart diseases [2].

Seven Diagnostic Tests

Test	What It Shows
Echocardiogram	Sound waves create pictures of the beating heart and show how blood flows through the heart and valves; helps determine how severe the disease is. Done outside the body (device pressed against the chest) or inside the body as a transesophageal echocardiogram (tube down the throat into the esophagus) when more detail is needed [2]
Electrocardiogram (ECG or EKG)	A quick test that records the electrical activity of the heart and shows how the heart beats; sensor patches go on the chest and sometimes the legs [2]
Chest X-ray	Shows the heart and lungs; can reveal a larger-than-usual heart, a sign of certain valve disease or heart failure [2]
Cardiac MRI	Magnetic fields and radio waves create detailed heart pictures; used to learn disease severity and measure the size of the aorta [2]
Cardiac CT scan	A series of X-rays makes detailed images of the heart and valves; measures the aorta's size, looks closely at the aortic valve, shows how much calcium is in the valve, and helps determine stenosis severity [2]
Exercise or stress tests	Walking on a treadmill or riding a bike while an ECG or echocardiogram runs; shows how the heart reacts to activity and whether symptoms occur during exercise. If you can't exercise, medicine can be given to affect the heart the way exercise does [2]
Cardiac catheterization	Not often used for diagnosis, but can assess severity or diagnose the condition if other tests can't; a thin flexible tube is guided through a blood vessel (usually groin or arm) to the heart; some heart treatments can be performed during it [2]

The Four Stages of Valve Disease

After testing confirms a diagnosis, the healthcare team may assign a stage — which helps determine the most appropriate treatment [2]. Staging depends on symptoms, disease severity, valve structure, and blood flow through the heart and lungs.

Stage	Name	What It Means
A	At risk	Risk factors for heart valve disease are present [2]
B	Progressive	Valve disease is mild or moderate; no symptoms [2]
C	Asymptomatic severe	Valve disease is severe but still no symptoms [2]
D	Symptomatic severe	Valve disease is severe and causing symptoms [2]

What are the treatment options for aortic valve disease?

Treatment depends on the stage of the disease, whether it is causing symptoms, and whether it is getting worse. It may include regular health checkups, lifestyle changes, medicines, or surgery or another procedure [2]. If the disease is mild or moderate or you have no symptoms, regular medical checkups and healthy lifestyle changes may be all that's needed [2].

Consider being evaluated at a medical center with a multidisciplinary team of cardiologists and other professionals trained in heart valve disease [2].

Medications

Medicines may treat symptoms or reduce complication risk — for example, to:

• Lower blood pressure

• Prevent irregular heartbeats

• Remove extra fluid from the body to reduce the strain on the heart [2]

Aortic Valve Repair

During repair, the surgeon may do one or all of the following:

• Separate valve flaps that have fused [2]

• Add support to the base of the valve [2]

• Reshape or remove extra valve tissue so the flaps close tightly [2]

• Patch holes or tears in a valve [2]

Repair often requires open-heart surgery, but less-invasive options may exist — for example, a catheter procedure to insert a plug or device that repairs a leaking replacement valve [2].

For infants and children with aortic valve stenosis, a less invasive option called balloon valvuloplasty may temporarily open a narrowed valve: a thin, flexible tube is inserted into a blood vessel (usually in the groin) and threaded to the heart, where a balloon on the tip inflates to widen the valve opening. This procedure may also be done in adults who are too sick for surgery or are waiting for a valve replacement [2].

Aortic Valve Replacement

In replacement, the surgeon removes the damaged valve and replaces it with one of two kinds:

Valve Type	What It Is
Mechanical valve	A man-made replacement valve
Biological (tissue) valve	A valve made from cow, pig, or human heart tissue [2]

Other replacement options include:

• TAVR (transcatheter aortic valve replacement) — a minimally invasive procedure for a narrowed valve that fails to open properly (stenosis). A thin, flexible tube is placed into the leg or chest and guided to the heart; the replacement valve travels through the tube, and a balloon expands to press it into place (some valves self-expand). TAVR uses smaller cuts than open-heart surgery and may suit people at increased risk of surgery complications [2].

• The Ross procedure — a more complicated surgery in which the aortic valve is replaced with your own lung valve (pulmonary valve), and that pulmonary valve is then replaced with a biological tissue valve [2].

Talk with your healthcare team about the benefits and risks of each valve type to choose the best option for you.

Aortic Valve Disease and Pregnancy

If you have aortic valve disease, talk with a healthcare professional before becoming pregnant [2]. Careful, regular checkups are needed during pregnancy, and the team will determine which medicines are safe and whether valve treatment is needed beforehand. Healthcare professionals may recommend that people with severe heart valve disease avoid pregnancy to reduce the risk of complications [2].

What heart-healthy steps help people with aortic valve disease?

After diagnosis or treatment, regular health checkups are essential. Your healthcare team may also recommend these heart-healthy steps:

1. Do not smoke or use tobacco. Smoking is a major risk factor for heart disease, and quitting is the best way to reduce the risk [2]. If you need help quitting, talk to a healthcare professional.

2. Eat healthy foods. Choose a variety of fruits and vegetables, low-fat or fat-free dairy, poultry, fish, and whole grains. Avoid saturated and trans fats, and excess salt and sugar.

3. Keep a healthy weight. Being overweight raises the risk of heart disease and other conditions [2]. Ask your team what a healthy weight is for you.

4. Get regular exercise. Staying active keeps the heart healthy — aim for at least 30 minutes a day on most days of the week [2], and ask your team about the amount and type that suit you.

5. Manage stress. Find ways to reduce emotional stress — get more exercise, practice mindfulness, and connect with others in support groups.

Frequently Asked Questions

What is aortic valve disease?

Aortic valve disease is a heart valve condition in which the aortic valve — the gate between the heart's lower left chamber and the aorta — doesn't work as it should. It takes two forms: stenosis (the valve narrows and blocks blood flow) and regurgitation (the valve leaks and lets blood flow backward).

What are the symptoms of aortic valve disease?

Symptoms may include chest pain or tightness, dizziness, fainting, unusual fatigue after activity, irregular heartbeat, and shortness of breath — especially during vigorous activity or when lying down. In children with stenosis, poor eating and poor weight gain are common. Importantly, some people have no symptoms for many years, and the first signs may resemble heart failure (fatigue that rest doesn't fix, shortness of breath, swollen ankles and feet). Call 911 for sudden chest pain.

Is aortic valve disease present at birth?

Aortic valve disease can be. A person may be born with the condition as a congenital heart defect — most classically a bicuspid aortic valve, which has two flaps instead of the usual three. It can also develop later in life from age-related changes, infections, high blood pressure, or heart injury.

What are the four stages of aortic valve disease?

Valve disease is staged as Stage A (at risk — risk factors present), Stage B (progressive — mild/moderate, no symptoms), Stage C (asymptomatic severe — severe but no symptoms), and Stage D (symptomatic severe — severe with symptoms). Staging is based on symptoms, severity, valve structure, and blood flow, and it guides treatment decisions.

Can aortic valve disease be treated with medicine?

Medicines cannot fix the valve itself, but they treat symptoms and reduce complication risk — for example, by lowering blood pressure, preventing irregular heartbeats, and removing extra fluid to ease strain on the heart. Eventually, many people need valve repair or replacement.

What is the difference between valve repair and replacement?

In repair, the surgeon separates fused flaps, reinforces the valve base, reshapes tissue, and patches holes — often through open-heart surgery. In replacement, the damaged valve is removed and replaced with a mechanical or biological (tissue) valve, via open-heart surgery or the minimally invasive TAVR procedure; a complex alternative is the Ross procedure, which uses your own lung valve.

What complications can aortic valve disease cause?

Without proper care, aortic valve disease can lead to blood clots, stroke, heart failure, arrhythmias (irregular heartbeats), and death from sudden cardiac arrest — which is why early diagnosis, staged monitoring, and timely treatment matter.

Conclusion

The main lessons from this guide are:

• Aortic valve disease means the heart's main exit valve narrows (stenosis) or leaks (regurgitation) — present at birth in some, developing from aging, infection, or high blood pressure in others, and often silent for years.

• Know the warning signs and act fast: chest pain, dizziness, fainting, fatigue, irregular heartbeat, and shortness of breath deserve a checkup — and sudden chest pain means calling 911.

• Staging guides treatment, and treatment works: from watchful checkups and lifestyle changes for mild cases, through medicines, to valve repair or replacement (including minimally invasive TAVR). Proper diagnosis and treatment significantly reduce the risk of stroke, heart failure, and sudden cardiac arrest.

We hope this complete guide has given you a clear understanding of aortic valve disease — its two forms, how it progresses through four stages, and the repair and replacement paths available. Because it shares causes with related conditions, you may also want to read our guide on aortic dissection, where the bicuspid aortic valve and other risk factors come up again.

Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you are experiencing a medical emergency — including sudden chest pain — call 911 or your local emergency number immediately.

References

1. Mayo Clinic. Aortic valve disease — Symptoms & causes. Accessed October 12, 2026. https://www.mayoclinic.org/diseases-conditions/aortic-valve-disease/symptoms-causes/syc-20355117

2. Mayo Clinic. Aortic valve disease — Diagnosis & treatment. Accessed October 12, 2026. https://www.mayoclinic.org/diseases-conditions/aortic-valve-disease/diagnosis-treatment/drc-20355122

3. Yadgir S, Johnson CO, Aboyans V, et al. Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990-2017. Circulation. 2020;141(21):1670-1680. PMID 32223336. https://doi.org/10.1161/CIRCULATIONAHA.119.043391

4. Fernandes Pedro J, Figueiredo ARM, Almeida R, et al. Growth rate of the ascending aorta and risk of aortic dissection or reintervention in patients with bicuspid or tricuspid aortic valves undergoing valve interventions: a systematic review and meta-analysis. Rev Port Cardiol. 2026;45(7):363-374. PMID 41932606. https://doi.org/10.1016/j.repc.2026.03.005

5. Attachaipanich T, Attachaipanich S, Kaewboot K. Balloon vs. self-expanding valves for transcatheter aortic valve implantation in bicuspid aortic stenosis: a meta-analysis. J Cardiovasc Med (Hagerstown). 2025;26(9):477-486. PMID 40977467. https://doi.org/10.2459/JCM.0000000000001757