I just received a question from Emma about the normal size of an aortic valve.

She writes, “Hi Adam, I’ve been diagnosed with severe aortic stenosis although I am asymptomatic. I believe I’m on the path to surgery as my echo shows a valve area of 0.9. I’m curious. What is the normal size of the aortic valve? Thanks for all you do! Emma”

Like Emma, I had this exact question when I was told by my first cardiologist (aka Dr. Bad Bedside Manner) that I needed heart valve replacement surgery.

To help Emma, please see the chart above which contains the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines for aortic stenosis. As shown, the severity of aortic stenosis can result from three criteria –  valve area (size), aortic velocity and aortic valve gradient.

Specific to size, a normal aortic valve area is >2 centimeters squared (cm2). If the valve area is between 1.5 and 2.0 cm2, the stenosis is mild; if the valve area is between 1.0 and 1.5 cm2, the stenosis is moderate; if the valve area is between 0.6 and 1.0 cm2, the stenosis is moderate-severe; areas of less than 0.6 cm2 constitute severe aortic stenosis.

If you are curious, here is a picture of a normal aortic valve:

And, here is a picture of a stenotic aortic valve that is bicuspid with calcified leaflets:

I hope that helps Emma (and all of us) learn a little more about aortic stenosis and aortic valve size.

Keep on tickin!

P.S. To leave a comment, please click here.

In response to our recent discussions about the progression of heart valve stenosis and rheumatic heart valve disease, I have received several emails about the anatomy of the heart and the anatomy of our heart valves. Most of these inquiries have come from patients recently diagnosed with some form of severe valvular disorder.

Interactive Heart Anatomy Tool At  www.MyHeartValveChoice.com

To help those patients (and perhaps you) learn more about human heart anatomy, you may want to visit www.MyHeartValveChoice.com. This website, which officially launched last week, contains an interactive section that describes heart anatomy and helps answer three key questions for patients and caregivers:

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Emma just emailed me an interesting question about aortic stenosis and the rate at which this form of heart valve disease progresses.

Aortic Valve Stenosis – Narrow Heart Valve

She writes, “Hi Adam – I’ve recently been diagnosed with moderate aortic stenosis even though I have no symptoms. My latest echocardiogram shows a valve area of 1.2 square centimeters. For now, my cardiologist says we’re in ‘Monitor Mode’ with the chance of surgery in the future. Do you know of any clinical studies that document the rate at which aortic stenosis progresses? I’d like to know how many years before I may need heart valve surgery. Thanks, Emma”

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Okay, here’s our heart valve trivia question for the day:

How many times do your four heart valves open-and-close every day?

A. 4,000
B. 40,000
C. 400,000
D. 4,000,000

According to The Cleveland Clinic, your heart beats about 100,000 every day. Considering there are four valves in the heart, which open-and-close with each heart beat, the answer is… 400,000.

To see how the heart valves open-and-close, watch this video titled, “How The Heart Works“.

Keep on tickin!

A 51-year-old Idaho woman has had to have three of four heart valves replaced, thanks to the now-banned diet drug, fen-phen. In a recent interview, Cindy Cartwright urged others like her who had taken fen-phen to undergo a medical evaluation, regardless how much time had passed since they had used the dangerous medication.

Cindy Cartwright – Triple Heart Valve Replacement Patient

Fen-phen was an anti-obesity medication (an anorectic) which consisted of two drugs: fenfluramine and phentermine. Fenfluramine, and later, a related drug, dexfenfluramine (Redux), was marketed by American Home Products, now known as Wyeth, but were shown to cause potentially fatal pulmonary hypertension and heart valve problems. Because of these serious side effects, the U.S. Food & Drug Administration (FDA) asked Wyeth to take both drugs off the market in 1997.

Cindy Cartwright began taking fen-phen 23 years ago to drop some weight she had gained following the birth of her youngest child. She only took the drug for six months, but more than two decades later, Cartwright’s health has suffered because of fen-phen.

For a little more than a year, Cartwright had been experiencing breathing difficulties that forced her to slow down while walking. According to her doctor, fen-phen caused her heart to expand almost reaching the chest walls. Inside, leaflets of her valves were supposed to be preventing blood from going backwards. Instead the valves weren’t coming together at all.

Because of the damage, Cartwright under went a triple heart valve replacement surgery early last week at Portneuf Medical Center. According to her cardiologist, having three of four heart valves replaced is uncommon. In most cases, valves can be repaired, but the damage caused by fen-phen is usually too severe.

“Unbelievable to think that my valves had just wore out because I’m a healthy person, a young person. It was hard to believe,” Cartwright told a local reporter.

According to her doctor, such damage, even decades after minor fen-phen use, is not unheard of. Following cardiac rehab, Cartwright is expected to make a full recovery. Considering herself fortunate, Cindy Cartwright has some advice for anyone who used fen-phen in the past: see a doctor right away – the sooner the better.

Keep on tickin’ Cindy!