Narrowing of the aortic valve is referred to as aortic stenosis. Caused by the inability of the valve to open normally, the heart has to work harder to pump blood past the narrow valve. This disease is mainly diagnosed using Doppler echocardiography and cardiac catheterization, according to the book "Current Diagnosis and Treatment: Cardiology", by Michael H. Crawford, M.D. Birth defects, valve degeneration, lupus, high cholesterol and rheumatic fever have all been implicated as underlying causes of aortic stenosis. Although three treatment options exist for this disease, the only effective and proven method has been aortic valve replacement, says Dr. Crawford.
Aortic Balloon Valvuloplasty
Aortic balloon valvuloplasty involves the placement of a relatively large balloon inside the aortic valve via catheterization. Once inside, the cardiologist inflates the balloon and the calcium deposits break and the valve stretches open. However, this treatment does not reduce stenosis to non-critical levels and the beneficial effect of the procedure goes away after 6 months in 50 percent of those treated, says the article, "Percutaneous Transcatheter Implantation of an Aortic Valve Prosthesis for Calcific Aortic Stenosis", by Alain Cribier, M.D. published in the journal "Circulation". This procedure provides only mild benefits and does not prevent fatality from complications related to aortic stenosis. Aortic balloon valvuloplasty is by no means an alternative to replacing a stenosed aortic valve. Effective use of this procedure is limited to reducing severe symptoms associated with aortic stenosis until the patient receives an aortic valve replacement, states Crawford.
Aortic Valve Replacement
Aortic valve replacement involves replacing the defective valve with a bioprosthetic valve, mechanical prosthetic valve or by using the patient's own pulmonic valve. According to Crawford, dramatic improvement in the heart's function occurs immediately after aortic valve replacement surgery. Even with patients in the most advanced stages of aortic stenosis, the amount of blood pumped by the heart can double. With time, the negative effects of aortic stenosis such as enlargement of the bottom left heart chamber can become reversed after this procedure. It is never too late for cardiologists to perform aortic valve replacement on aortic stenosis patients, except for when contraindications to having the surgery exist.
Aortic Valve Debridement
The calcium deposits causing aortic valve stenosis can be debrided or removed using surgical and ultrasound methods. Removing calcium deposits with surgery can result in a gradual worsening of the stenosis after the procedure. The use of ultrasound waves to break up calcium deposits in the aortic valve produces significant results 6 months after surgery; however, the procedure eventually leads to aortic insufficiency in many patients, says Dr. Cribier As with aortic ballon valvuloplasty, surgical and ultrasound debridement is considered a poor alternative to aortic valve replacement.
Drug Therapy
Currently, aortic valve stenosis cannot effectively be treated using pharmaceutical drugs. Medication may actually prove harmful and worsen existing complications related to the disease, says Crawford.
References
- "Current Diagnosis and Treatment: Cardiology"; Aortic Stenosis; Michael H. Crawford, M.D.; 2009
- "Circulation"; Percutaneous Transcatheter Implantation of an Aortic Valve Prosthesis for Calcific Aortic Stenosis; Alain Cribier, M.D.; 2002
