MedicineNet.com
About Us | Privacy Policy | Site Map
November 23, 2009
MedicineNet home Picture Slideshows Diseases and conditions Symptoms and signs Procedures and tests Medications Health and Living Picture Image Collection MedTerms medical dictionary
Font Size
A
A
A

Aortic Stenosis (cont.)

How is aortic stenosis treated?

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 in which bacteria may be introduced 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 (E-Mycin, Eryc, PCE), as well as intramuscular or intravenous ampicillin (Unasyn), gentamicin (Garamycin), and vancomycin (Lyphocin, Vancocin).

When symptoms of chest pain, syncope, or shortness of breath appear, the prognosis for patients with aortic stenosis without valve replacement surgery is poor. Medical therapy, such as the use of diuretics to reduce high lung pressures and remove lung fluid can provide only temporary relief of symptoms. Patients with symptoms usually undergo cardiac catheterization. If severe aortic stenosis is confirmed, aortic valve replacement is usually recommended. The overall mortality risk for aortic valve replacement surgery is about 5%. Advanced age should not be a reason for not recommending aortic valve replacement for aortic stenosis. Otherwise healthy patients in their 80s with strong heart muscles often benefit dramatically from aortic valve replacement for critical aortic stenosis.

Replacement aortic valves processed from pigs (porcine) or cows (bovine) are called bioprostheses. Bioprostheses are less durable than mechanical prostheses (discussed below) but have the advantage of not needing life-long blood thinning (anticoagulation) medication to prevent blood clots from forming on the valve surfaces. The average life expectancy of an aortic valve bioprostheses is 10 to 15 years. Bioprostheses rapidly calcify, degenerate and narrow in young patients. Therefore, bioprostheses are primarily used in patients over 75 years old or in patients who cannot take blood thinners. Recently, aortic valves from human cadavers have been used in younger patients to avoid the need for anticoagulation medication.  However, the availability of human aortic grafts is limited; though probably better than the other bioprostheses, its long term durability is unknown. The new "Ross Procedure" consists of moving the pulmonic valve to the aortic position and replacing the pulmonic valve with a valve from a human donor. This procedure has not been performed long enough to evaluate the long-term performance of the pulmonic valve when moved to the aortic position.

Mechanical prostheses have proven to be extremely durable and can be expected to last from 20 to 40 years. However, mechanical prosthetic valves all require life-long anticoagulation with blood thinners such as warfarin (Coumadin) to prevent clot formation on the valve surfaces. Otherwise, blood clots dislodged from these valves can travel to the brain and cause embolic stroke or embolic problems in other parts of the body. The original caged-ball Starr-Edwards prosthesis of the 1960s was replaced by the tilting disc Bjork-Shiley of the 1970s and early 1980s. Although the Bjork-Shiley valve provided a larger opening for blood flow, a second generation model of the valve posed the risk of potential breakage resulting in death, and is no longer available in the United States. The tilting pivoting disc Hall-Medtronic valve and the two leaflet (bileaflet) carbon St. Jude valve are commonly used mechanical prostheses today. These valves provide excellent flow characteristics but require life-long anticoagulation with blood thinners such as warfarin (Coumadin), to prevent embolic complications.

The aortic valve area can be opened or enlarged with a balloon catheter (balloon valvuloplasty) which is introduced in much the same way as in cardiac catheterization. With balloon valvuloplasty, the aortic valve area typically increases slightly. Patients with critical aortic stenosis can therefore experience temporary improvement with this procedure. Unfortunately, most of these valves narrow over a six to 18 month period. Therefore, balloon valvuloplasty is useful as a short-term measure to temporarily relieve symptoms in patients who are not candidates for aortic valve replacement. Patients who require urgent noncardiac surgery, such as a hip replacement, may benefit from aortic valvuloplasty prior to surgery. Valvuloplasty improves heart function and the chances of surviving non-cardiac surgery. Aortic valvuloplasty can also be useful as a bridge to aortic valve replacement in the elderly patient with poorly functioning ventricular muscle. Balloon valvuloplasty may temporarily improve ventricular muscle function, and thus improve surgical survival. Those who respond to valvuloplasty with improvement in ventricular function can be expected to benefit even more from aortic valve replacement. Aortic valvuloplasty in these high risk elderly patients has a similar mortality (5%) and serious complication rate (5%) as aortic valve replacement in surgical candidates.

Aortic Valve Stenosis At A Glance
  • Aortic stenosis is narrowing of the aortic valve, impeding delivery of blood from the heart to the body.

  • Aortic stenosis can be caused by congenital bicuspid aortic valve, scarred aortic valve of rheumatic fever, and wearing of aortic valve in the elderly.

  • Aortic stenosis can cause chest pain, fainting, and heart failure leading to shortness of breath.

  • Echocardiogram and cardiac catheterization are important tests in diagnosing and evaluating severity of aortic stenosis.

  • Patients with aortic stenosis are usually given antibiotics prior to any procedures which might introduce bacteria into the bloodstream, such as dental procedures and surgeries.

  • Patients with aortic stenosis who have symptoms may require surgical heart valve replacement.

Last Editorial Review: 7/20/2007


Aortic Stenosis - Describe Your Experience

The MedicineNet physician editors ask:

Please describe your experience with aortic stenosis.

Comment submissions for this question have ended. Patient Discussions FAQs
See 22 Viewer Comments

View Comments


Printer-Friendly Format  |  Email to a Friend


Suggested Reading by Our Doctors
MedicineNet Doctors
  • Ultrasound - Learn an ultrasound procedure, and conditions and diseases it assists in diagnosing and screening like tumors, cysts, heart conditions and more.
  • Low Blood Pressure - Learn about low blood pressure (hypotension). Low blood pressure is blood pressure below normal and symptoms may include: lightheadedness, dizziness, fainting upon standing (orthostatic hypotension). There are many causes of low blood pressure, and treatment is dependant upon the cause.
  • Echocardiogram - Information on Echocardiogram including why you would need one, the types of echocardiograms, how to prepare and what to expect.

Latest Medical News


Heart Health

Get the latest treatment options.


Are you Depressed? Take the Quiz

Your Guide to Symptoms & Signs: Pinpoint Your Pain












Health categories:

Slideshows | Diseases & Conditions | Symptoms & Signs | Procedures & Tests | Medications | Health & Living | News & Views | Medical Dictionary

Popular health centers:

Allergies | Arthritis | Cancer | Diabetes | Digestion | Healthy Kids | Heart | Men's Health | Mental Health | Women's Health | More...

Publications:

ePublications (PDFs) | XML News via RSS | Audio Podcasts | Email Newsletters

MedicineNet.com:

About Us | Privacy Policy | Site Map | WebMD® | Medscape® | eMedicine® | eMedicineHealth® | RxList®

This website is certified by Health On the Net Foundation. Click to verify. This site complies to the HONcode standard for trustworthy health information:
verify here.

©1996-2009 MedicineNet, Inc. All rights reserved. Notices and Legal Disclaimer.
MedicineNet does not provide medical advice, diagnosis or treatment. See additional information.