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 follow-up appointments, your doctor will review your medical history and conduct a physical examination. Your doctor may also discuss symptoms and what to expect as your condition progresses.

Your doctor may order an echocardiogram to view your aortic valve and monitor your condition every three to five years if you have mild aortic valve stenosis, and every year if you have moderate aortic valve stenosis.

If you have severe aortic valve stenosis, your doctor may schedule checkups every three to six months. Your doctor may order an echocardiogram every six to 12 months to view your heart valve and monitor your condition. In some cases, your doctor may order additional tests.

In general, surgery is necessary when narrowing becomes severe and symptoms develop. In some cases, your doctor may recommend surgery if you have severe aortic valve stenosis even if you aren't experiencing symptoms. If you have moderate or severe aortic valve stenosis and other conditions that require heart surgery, your doctor may recommend surgery to treat your conditions.

Medications

No medications can reverse aortic valve stenosis. However, your doctor may prescribe certain medications to help your symptoms, such as ones to reduce fluid accumulation, to slow your heart rate or to control heart rhythm disturbances associated with aortic valve stenosis. Lowering blood pressure may prevent or slow the development of aortic stenosis. Ask your doctor if you need to lower your 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. Occasionally, balloon valvuloplasty 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 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 the 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 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 or are waiting for a transcatheter aortic valve replacement.

  • Aortic valve replacement. This is the primary surgical treatment for severe aortic valve stenosis. Your surgeon removes the narrowed aortic valve and replaces it with a mechanical valve or a tissue valve. This procedure is generally performed during open-heart surgery.

    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 narrow over the years and need to be replaced. Another type of tissue valve replacement that uses your own pulmonary valve (autograft) is sometimes possible but less likely in an older person. Your doctor can discuss the risks and benefits of each type of heart valve with you. Aortic valve replacement can relieve aortic valve stenosis and its symptoms.

  • 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).

    In TAVR, doctors insert a catheter with a balloon at the tip in an artery in your leg or in a small incision in your chest and guide it to your heart and into your aortic valve. A balloon at the tip of the catheter, which has a folded valve around it, is then inflated. This pushes open the aortic valve and stretches the valve opening and expands the folded valve into the aortic valve. Doctors then deflate the balloon and guide the catheter with the balloon back out of your body. Alternatively, a self-expanding valve may be inserted into the aortic valve, and a balloon then isn't used.

    In some cases, a valve can be inserted via a catheter into a tissue replacement valve that needs to be replaced (valve-in-valve procedure).

    TAVR is usually reserved for individuals with severe aortic valve stenosis who are at increased risk of complications from aortic valve surgery. This procedure can relieve severe aortic valve stenosis and its symptoms in those who are at increased risk of complications from aortic valve surgery. TAVR has a higher risk of stroke and vascular complications than aortic valve replacement surgery. The technique is relatively new and is evolving quickly, and there are newer valves and indications occurring frequently. 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'll need regular follow-up appointments with your doctor to check for any changes in your condition. 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 valve stenosis, you may need medications to treat heart failure.

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

Sep. 13, 2014

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