Surgery for Aortic Stenosis

by Michael_Koger

When stenosis of the aortic valve becomes severe, surgery may be the next step.

Some clients with aortic stenosis will develop symptoms such as shortness of breath, fainting spells, and anginal chest discomfort. Their exercise tolerance will not be as good as it has been. Additionally, many of these patients experience a sensation of palpitations or fluttering in the chest. When these take place, prognosis is poor, and surgery is the recommendation [1. 2].

Without the operation, mortality rate at three years is 75 percent. The American Heart Association and American College of Cardiology provide the guidelines for these situations [1, 2].

Some who have this infirmity do not have signs or symptoms. Many of those clients remain that way for years despite the presence of severe disease, and the necessity of a surgical procedure in these cases is controversial in the literature. [1, 2].

Nevertheless, the approach to decision about surgery has changed over the decades because of improvements in surgical techniques and prostheses. This has led to lower rates of complication from the procedure and therefore a decline in mortality. Moreover, researchers anticipate that these results will continue to change for the better, and cardiac surgeons will perhaps proceed with the operation at earlier stages of the illness than they have in the past [1, 2].

Diagnostic Examinations

There are, however, many diagnostic examinations which enable the physician to resolve questions about the indication of an operation.  For example, echocardiography is a good way to first evaluate someone who may have this medical condition.  This will delineate mean pressure gradient across the valve, velocity through the valve, valve area, and ejection fraction [1, 2].

In fact, an ejection fraction of less than 50 percent in these clients will serve as another criterion for surgical management as there is otherwise a poor prognosis in those patients.  At the same time, the clinician must remember that the ejection fraction has its limitations in determination of what the client’s left ventricular function really is [1, 2].

Treadmill Exercise Test

Though the treadmill exercise test has long been useful for the evaluation of coronary heart disease, it is not suitable for a patient who has symptomatic severe aortic stenosis.  The use of an exercise tolerance test in these individuals can lead to syncope and malignant rhythm disturbances of the heart.  Hence, its use in such scenarios is a medical contraindication [1, 2].

For those with this illness who are physically active and asymptomatic, it is, however, reasonable to perform an exercise test with modification.  If symptoms do occur in these instances, then replacement of the aortic valve is likely necessary [1, 2].

Conclusion

The evaluation and management of those who have aortic stenosis requires careful history, physical examination, and other assessments to arrive at a sound treatment plan.

References

  1. McCarthy, C., Phelan, D. and Griffin, B.  (2016).  When does asymptomatic aortic stenosis warrant surgery?  Assessment techniques.  Cleveland Clinic Journal of Medicine, 83, 271-280.
  2. American Heart Association.  (2013).  Problem:  Aortic Valve Stenosis.  Retrieved May 4, 2016.
  3. The photo shows damage from a stenotic aortic valve in a patient with rheumatic heart disease.  Reprinted with permission from U.S. Centers for Disease Control/Dr. Edwin P. Ewing, Jr.

Disclaimer

The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.

Updated: 05/16/2016, Michael_Koger
 
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