heart and blood vessel disorders
Aortic Stenosis
Treatment of Aortic Stenosis
Valve replacement Adults who have aortic stenosis but no symptoms should see their doctor regularly and should avoid overly stressful exercise. Echocardiography and Other Ultrasound Procedures is done periodically, at intervals determined by the severity of the stenosis, to monitor heart and valve function. Before surgery, heart failure is treated with diuretics (see table). Treating angina is often difficult becausenitroglycerin, which is used to treat angina in people who have coronary artery disease, can rarely cause dangerously low blood pressure and worsen the angina in people with aortic stenosis. Sometimes, in children and young adults who were born with a defective valve, the valve can be stretched open using a procedure called balloon valvotomy. In this procedure, a catheter with a balloon on the tip is threaded through a vein or artery into the heart ( Cardiac Catheterization and Coronary Angiography ). Once across the valve, the balloon is inflated, separating the valve cusps. In people who have aortic stenosis that causes any symptoms (particularly shortness of breath on exertion, angina, or fainting), or if the left ventricle begins to fail, the aortic valve is replaced. Replacement of the abnormal valve is the best treatment for nearly everyone, and the prognosis after valve replacement is excellent. Aortic valve replacement was traditionally done via open-heart surgery. (See the video.) Increasingly, older people can have their valve replaced through a catheter threaded up the femoral artery in a procedure called transcatheter aortic valve implantation (TAVI). TAVI is generally better than medical therapy and similar to surgical valve replacement for these people. People with an artificial valve must take antibiotics before a surgical, dental, or medical procedure (see table) to reduce the risk of an infection on the valve (infective endocarditis). 