Treatment of Aortic Stenosis
Medicine has little to contribute in the treatment of aortic valve stenosis. In mild cases, it is nonessential and in critical ones, medicine is ineffective. However, it is essential that for all patients with aortic stenosis, treatment, irrespective of the severity, should have a prophylactic antibiotic for potentially septic danger. Patients with moderate aortic stenosis (obstructive valve area 1.5 to 1.0 square centimeters)are recommended to refrain stressful activities such as heavy weight exercises. Aortic stenosis has been on the upswing in the last few years. Therefore, patients are advised to have their examination done annually and have monitoring of the condition done by echo-cardiography evaluations.
Patients with a severe left ventricular anomaly and fluid retention will profit from from a treatment of bed rest and treatment with a diuretic before any surgery is contemplated. Prolonged treatment of these patients with large doses of powerful diuretics merely produces potassium depletion with a corresponding increase in the risk of post-operative rhythm disturbances. In North America, Asia, Australia and Western Europe, aortic stenosis effects mainly older people. Calcific aortic stenosis is often seen in middle age as a result of congenital bicuspid aortic valve.
Treatment of Aortic Stenosis
Treatment of aortic stenosis in critical cases is surgery, and aortic valve replacement in these cases is an extremely effective operation. In uncomplicated cases, balloon angioplasty and surgical valvotomy are the operations of choice.
Balloon angioplasty
Balloon angioplasty may be the only intervention indicated but is often used as a transient means to hold off open-heart surgery. During the procedure, thin plastic tubes, known by the name of catheters are positioned in the large blood vessels in the legs and carefully guided to the heart. The tip of the catheter is inserted across the aortic valve and the balloon is filled with air. The balloon gradually dilates the narrowed area and allows proper flow of blood. There are very few chances of complications which include perforation, hemorrhage , injury to femoral artery, and aortic valve perforation. The incidence of post-operative complications is low and includes damage to the femoral artery, bleeding, perforation, and aortic valve leakage. This approach is usually confined to those with congenital aortic stenosis; mainly in children or adolescents.
Surgical valvotomy
During the performance of this surgery, the chest is opened by means of a longitudinal incision along the sternum. The heart is ceased for a small while and the body is supported by a heart lung bypass machine. An incision is made in the ascending aorta where it exits the left ventricle and an instrument called a dilator is then installed through the opening of the aortic artery. This instrument allows dilation and subsequent opening of the artery but care must be taken not to over-dilate since that would stretch the valve beyond its capacity and allow a back-flow of blood into the ventricle.
Aortic valve replacement In case of severe damage to the valve, it has to be surgically replaced with an artificial valve. In some cases, the patient`s own pulmonary valve may be used and this procedure is known as Ross OperatioMedical or a pulmonary auto-graft. Valve replacements alone are not always enough to repair the narrowing of the aorta where is leaves the ventricle. Sometimes the whole area leading out of the ventricle to the aorta is too small even if the leaflets are opened apart to the maximum. In such cases, the valve replacement is done with a technique known as Konno procedure. In this technique, the left ventricular outflow tract and the ring of the valve are enlarged. Although the risks of surgical treatment of aortic stenosis are higher ,the excellent improvement in the patient's health as compared to the poor prognosis if untreated, makes the option of surgery attractive.