Treatment of Aortic Valve Stenosis

The aortic valve consists of three flexible cup-shaped leaflets at the base of the aorta that are forced apart when the left ventricle contracts. The powerful contraction of the left ventricle pushes pressurized blood through the valve into aorta where it is then carried to the rest of the body. When the ventricle has emptied, the three leaflets snap back together in complete contact with each other.

The wear and tear of constant valve motion over many years can lead to calcification of the valve. This accumulation of calcium causes the valve to be stiff, or stenosed, and it begins to work imperfectly. When calcification occurs as the result of an individual aging it is referred to as age-related degenerative calcific changes' or senile aortic stenosis'. Age-related aortic stenosis affects approximately 2% of people over 65 years old. The prevalence is even higher at 75 and 85 years of age.

Calcific changes that progress to aortic stenosis can develop in two other groups of people: those born with an abnormal biscuspid (rather than tricuspid) valve and those with chronic rheumatic valve disease resulting from rheumatic fever as a child or young adult.

Most individuals won't experience any symptoms early in the course of the disease. When it becomes symptomatic, aortic valve stenosis can cause several major health problems: chest pain (angina), fainting with exercise (exertional syncope), atrial fibrillation (palpitations), and congestive heart failure (shortness of breath, angina, peripheral edema). If the aortic valve stenosis goes untreated, the median survival time with any of these symptoms is only around 5 years. The median survival time for untreated individuals who develop atrial fibrillation in the setting of aortic stenosis is only 6 months!

The treatment for aortic stenosis consists of fairly minor lifestyle changes, occasional medications, and eventual surgery.

Non-surgical Treatment of aortic valvular stenosis:
-Avoid any strenuous activity.
-Avoid, or use with caution, any medications that could result in low blood pressure in the setting of aortic stenosis (vasodilators, diuretics, nitroglycerin).
-Use antibiotic prophylaxis to prevent infectious endocarditis when undergoing dental, gastrointestinal or urinary procedures.

Surgical Treatment of aortic valvular stenosis:
-Percutaneous valvuloplasty is a temporary measure. This involves inflating a balloon in the stiffened aortic valve to fracture the calcified areas. Symptoms improve immediately but, unfortunately, 50% of patients develop restenosis of the valve within only 6 months.
-Aortic Valve replacement is the definitive therapy. Replacing the aortic valve can double the life expectancy of an individual with symptomatic aortic stenosis.