Treatments and drugs

By Mayo Clinic Staff

Medications sometimes can ease symptoms of aortic valve stenosis. However, the only way to eliminate aortic valve stenosis is surgery to repair or replace the valve and open up the passageway.

Surgery isn't always needed right away. If tests reveal that you have mild to moderate aortic valve stenosis and you have no symptoms, your doctor will schedule checkups to carefully monitor the valve so that surgery can be done at the appropriate time.

In general, surgery is necessary when narrowing becomes severe and symptoms develop. Some people never develop severe aortic valve stenosis, so they never need surgery. For others, the condition gets worse and surgery is necessary.

Medications

No medications can reverse aortic valve stenosis. However, your doctor may prescribe certain medications to help your heart, such as ones to control heart rhythm disturbances associated with aortic valve stenosis. Lowering blood pressure or cholesterol may prevent or slow the development of aortic stenosis. Ask your doctor if you need to lower your cholesterol or blood pressure with medications.

Procedures

You may need valve repair or replacement to treat aortic valve stenosis. Although less invasive approaches are possible in some cases, surgery is the primary treatment for this condition.

Therapies to repair or replace the aortic valve include:

  • Balloon valvuloplasty (valvotomy). Occasionally, repairing the aortic valve is an option. Balloon valvuloplasty uses a soft, thin tube (catheter) tipped with a balloon. A doctor guides the catheter through a blood vessel in your arm or groin to your heart and into your narrowed aortic valve. Once in position, a balloon at the tip of the catheter is inflated. The balloon pushes open the aortic valve and stretches the valve opening, improving blood flow. The balloon is then deflated and the catheter with balloon is guided back out of your body. Balloon valvuloplasty may relieve aortic valve stenosis and its symptoms, especially in infants and children. However, in adults, the procedure isn't usually successful, and the valve tends to narrow again even after initial success. For these reasons, doctors rarely use balloon valvuloplasty today to treat aortic valve stenosis in adults, except in people who are too sick to undergo surgery.
  • Aortic valve replacement. This is the primary surgical treatment for aortic valve stenosis. Your surgeon removes the narrowed aortic valve and replaces it with a mechanical valve or a tissue valve. Mechanical valves, made from metal, are durable, but they carry the risk of blood clots forming on or near the valve. If you receive a mechanical valve, you'll need to take an anticoagulant medication, such as warfarin (Coumadin), for life to prevent blood clots. Tissue valves — which may come from a pig, cow or human deceased donor — often eventually need to be replaced. Another type of tissue valve replacement that uses your own pulmonary valve (autograft) is sometimes possible. Your doctor can discuss the risks and benefits of each type of heart valve with you.
  • Transcatheter aortic valve replacement (TAVR). Aortic valve replacement, the most common treatment for aortic valve stenosis, has traditionally been performed with open-heart surgery. A less invasive approach — transcatheter aortic valve replacement — involves replacing the aortic valve with a prosthetic valve via the femoral artery in your leg (transfemoral) or the left ventricular apex of your heart (transapical). TAVR is usually reserved for individuals at increased risk of complications from aortic valve surgery. TAVR is sometimes referred to as transcatheter aortic valve implantation (TAVI).
  • Surgical valvuloplasty. In rare cases, surgical repair may be a more effective option than balloon valvuloplasty, such as in infants born with an aortic valve in which the leaflets of the valve are fused together. Using traditional surgical tools, a cardiac surgeon operates on the valve and separates these leaflets to reduce stenosis and improve blood flow.

Aortic valve stenosis can be treated effectively with surgery. However, you may still be at risk of irregular heart rhythms even after you've been treated for aortic valve stenosis. You may need to take medications to lower that risk. If your heart has become weakened from aortic stenosis, you may need medications to treat heart failure.

If you've had aortic valve replacement surgery, you may need to take antibiotics before certain dental or medical procedures due to the risk of infection in your heart tissue (endocarditis).

Jul. 13, 2012