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Aortic Stenosis
Calcific Aortic Stenosis is often a disease seen in the elderly. Symptomatic patients may report chest pain (angina), loss of consciousness (syncope), or shortness of breath (congestive heart failure). When severe or critical aortic stenosis is present and the patient has one of the symptoms mentioned above, surgery to replace the aortic valve is best course of action. However, many patients have other illnesses or problems that impose a high risk for major complications from cardiac surgery. Others have one of more contraindications for valve replacment. For these carefully selected patients, palliative (symptom relieving) Balloon Aortic Valvuloplasty can be offered. This procedure is not as durable as surgery nor does it offer the same benefits in terms of altering the natural history of the disease as is found with aortic valve replacement. Nevertheless, it is a resonable procedure for carefully selected patients who are otherwise unacceptable surgical candidates. The balloon procedure usually results in symptom improvement and increased functional capacity for the next 6-18 months. While re-narrowing of the valve is not uncommon, the procedure can be repeated safely and effectively if necessary. Balloon Aortic Valvuloplasty is performed in the cardiac catheterization lab in a manner similar to other types of cardiac catheterization including coronary angioplasty. An overnight hospital stay is almost always required. Most patients can be discharged within 24-48 hours after the procedure. The procedure first involves determining the severity of the aortic valve disease and identification of the coronary artery anatomy. For patients with left ventricular dysfunction, congestive heart failure, or low cardiac output states, hemodynamic evaluation may be required to determine if the failing left ventricle is likely to improve with relief of the aortic valve obstruction. In general terms, this may entail an inotropic challenge designed to increase cardiac output to determine what happens to the pressure gradient. Patients in whom the gradient is unaffected by increasing cardiac ouptut are unlikely to benefit from the procedure. Increased cholesterol (>200), smoking, and elevated creatinine and calcium have been linked to an increased rate of Aortic Stenosis progression. Patients with these characteristics tend to narrow their aortic valve area at a faster rate compared to patients without these risk factors. Interestingly, those who initially present with mild degrees of aortic valve narrowing tend to progress more rapidly compared to patients with more severely narrowed valves at initial diagnosis ( Palta, Circulation, 2000 )
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