What's the treatment for aortic stenosis?
Medical decision-making for patients with aortic stenosis includes many factors including the location of the narrowing, severity of narrowing, associated cardiac problems, symptoms, age, and size. Patients without symptoms can be observed until symptoms develop. Patients with mild aortic stenosis do not require treatment or restriction of activity. Patients with moderate aortic stenosis (valve area 1.5 to 1.0 square centimeters) are advised to avoid strenuous activities such as weight lifting or sprinting. Aortic stenosis can progress over a few years. Therefore, patients are usually examined annually and
evaluated by echocardiography periodically to monitor disease progression. Since valve infection (endocarditis) is a serious complication of aortic stenosis, these patients are usually given antibiotics prior to any procedure which may introduce bacteria into the bloodstream. This includes routine dental work, minor surgery, and procedures that may traumatize body tissues such as colonoscopy and gynecologic or urologic examinations. Examples of antibiotics used include oral amoxicillin (Amoxil) and erythromycin (Emycin, Eryc, Pce), as well as intramuscular or intravenous ampicillin, gentamicin, and vancomycin
Balloon angioplasty for valvar aortic stenosis: Aortic stenosis often progresses over time. Balloon angioplasty may be the only intervention required but is often used as a temporary means to delay open-heart surgery. This procedure is done in the heart catheterization laboratory. During the procedure, catheters (thin plastic tubes) are placed into the large blood vessels in the legs and gently guided to the heart. The catheter tip is placed across the aortic valve and the balloon tip is inflated. The balloon gently dilates the narrowed area. The incidence of complications is low and includes damage to the femoral artery, bleeding, perforation, and aortic valve leakage.
Surgical valvotomy: When the surgeon performs this operation an incision is made down the center of the breastbone. The heart is stopped for a brief period of time while the body is supported with a heart lung bypass machine. The defect is then fixed by making an incision into the ascending aorta where it exits the left ventricle. An instrument called a dilator is then placed through the aorta and through the opening of the aortic valve stretching it. Progressively larger dilators are used until the valve is opened as much as possible without overstretching the valve which would allow it to leak blood backwards into the ventricle.
Valve replacement surgery: Patients with aortic stenosis often have blockages in the coronary arteries, or coronary artery disease (CAD), surgeons typically treat significant blockages by performing bypass surgery at the same time. For this reason, most patients undergo cardiac catheterization before valve replacement surgery to detect blockages in the coronary arteries. Valve replacement surgery is usually indicated in patients who have been diagnosed with severe AS, regardless of symptoms, and especially if dyspnea, angina, or syncope is present. Strenuous physical exertion should be avoided in those with severe AS. Valve replacements alone are not always enough to relieve the narrowing out the ventricle. Sometimes the whole area leading out of the ventricle to the aorta is too small. The supporting structure of the valve, called the valve annulus, may be too narrow even if the leaflets are opened up as far as possible. In these cases the valve replacement is performed with a procedure called a Konno procedure. This involves enlarging the left ventricular outflow tract and the valve ring. It is done through an incision into the outflow tract of the right ventricle and the septum or wall between the right and left ventricles. A patch is placed in this area that enlarges it. The Konno procedure can be done with any type of aortic valve replacement.
More information on aortic stenosis and other aortic valve diseases
What is aortic stenosis? - Aortic valve stenosis is a heart condition caused by narrowing of the aortic valve. Aortic stenosis is the inability of the aortic valve to open completely.
What causes aortic stenosis? - Congenital aortic stenosis is caused by improper development of the aortic valve in the first 8 weeks of fetal growth. Age related calcification of the valve is the most common cause.
What're the symptoms of aortic stenosis? - Symptoms of aortic stenosis include shortness of breath (dyspnea), passing out (syncope), and chest pain (angina pectoris).
How is aortic stenosis diagnosed? - Aortic stenosis is often diagnosed due to the presence of a heart murmur. The gold standard for diagnosis is an echocardiogram.
What's the treatment for aortic stenosis? - Patients with mild aortic stenosis do not require treatment. Valve replacement surgery is indicated for patients with severe aortic stenosis.
What's aortic valve regurgitation? - Aortic valve regurgitation develops hen the valve leaflets fail to close properly during the heart's relaxation phase.
What causes aortic valve regurgitation? - Causes of aortic valve regurgitation include being born with a defective aortic valve, wear and tear from aging, infection of the lining of the heart.
What're the symptoms of aortic regurgitation? - Symptoms of aortic regurgitation include chest pain, excessive sweating, palpitations, shortness of breath that worsens with exertion or lying down.
How is aortic valve regurgitation diagnosed? - A doctor diagnoses aortic valve regurgitation by hearing a heart murmur or other abnormal noises when listening with a stethoscope.
What're the treatments for aortic regurgitation? - Medicines to improve the pumping action of the heart may be given to reduce the severity of the regurgitation. Valve replacement surgery is usually recommended.
What is an aortic aneurysm? - An aortic aneurysm is a localized dilatation or aneurysm of the aorta, usually representing an underlying weakness in the wall of the aorta at that location.
What causes an aortic aneurysm? - Most aortic aneurysms occur in the abdominal aorta, the main cause being arteriosclerosis. There is a familial tendency to aortic aneurysms.
What're the symptoms of aortic aneurysm? - Most intact aortic aneurysms do not produce any symptoms. The ballooning of the aneurysm does not cause any symptoms unless it becomes large enough.
What're the complications of aortic aneurysm? - Half of all persons with untreated abdominal aortic aneurysms die of rupture within 5 years. Spontaneous blockage of the aorta can also occur.
How is aortic aneurysm diagnosed? - Aortic aneurysms can be diagnosed from their symptoms. An ultrasound scan is the easiest way to detect an aortic aneurysm.
What's the treatment for aortic aneurysms? - Medical therapy of aortic aneurysms involves strict blood pressure control. Symptomatic aneurysms require surgical treatment to prevent complications.
What's an abdominal aortic aneurysm (AAA)? - An abdominal aortic aneurysm (AAA) is a bulge in the aorta in abdomen. Most AAAs occur in association with advanced atherosclerosis.
What're the symptoms of abdominal aortic aneurysm? - Symptoms of abdominal aortic aneurysm include a pulsing sensation in the abdomen, and pain ranging from mild to severe.
How is abdominal aortic aneurysm diagnosed? - Because abdominal aortic aneurysms may not cause any symptoms at the beginning, they are diagnosed by chance during a physical examination.
What's the treatment for abdominal aortic aneurysm? - Treatment of abdominal aortic aneurysm depends upon the size of the aneurysm. Surgical treatment of abdominal aortic aneurysm is often preformed.
What is aortic valve disease? - An aortic valve disorder usually does not cause any symptoms in its early stages. Infection on an abnormal aortic valve leads to a disease called infective endocarditis.
What is aortic insufficiency? - Aortic insufficiency is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole.
Aortic valve replacement surgery - Aortic valve replacement surgery is an open heart procedure for treatment of narrowing (stenosis) or leakage (regurgitation) of the aortic valve.