Treatment and Prognosis

Aortic Stenosis – Treatment and Prognosis

Treatment is usually aimed at improving cardiac output and controlling abnormal heart rhythms (dysrhythmias)

Monitoring:
- for asymptomatic or mild cases
- Symptomatic patients – physical exam every 6-12 months, ECG every 1-3 years
- Echocardiography is performed periodically to monitor heart and valve function, helps doctors determine when to schedule surgery

Medications:
- to prevent heart failure (diuretics, digoxins)
- b-blockers (propranolol)
- calcium channel blokers (diltiazem)
- treating angina is often difficult because drugs used to treat angina (nitroglycerin) in people with CAD worsens the angina in people with AS

Hospitalization – for moderate to severe cases

Lifestyle patterns such as maintaining physical activity while avoiding hard physical exercise, control of weight and avoidance of smoking

Surgery

Two main surgical procedures:

· Aortic valve replacement
- surgically replaced with artificial valve (preferably before the left ventrical is irreversibly damaged)
- pulmonary autograft/Ross operation (person’s own pulmonary valve used)
- high risk patients – poor candidates
- best treatment for adults of all ages

· Balloon valvuloplasty (less invasive)
- catheter is inserted into blood vessel (artery) in groin and threaded up to heart
- tip of catheter is placed inside the aortic valve and balloon is inflated – stretch and widen the valve – improve blood flow to heart
- usually limited to those with congenital AS usually in children. However later when children are fully grown, the valve usually must be replaced.
- In adults, stenosis usually always recurs after balloon valvuloplasty; so among adults this procedure is used for frail older people who cannot tolerate surgery.

While balloon valvuloplasty has not yet been proven to be successful, aortic valve replacement has an excellent prognosis

Although AS is curable by surgery, there may be continued risk for arrhythymias which may sometimes cause sudden death

Without surgery, probable outcome is poor if there are signs of angina or heart failure

Person with AS should not participate in strenuous activities such as competitive sports

http://health.allrefer.com/health/aortic-stenosis-prognosis.html
http://merck.com/mmhe/sec03ch028/ch028f.html
http://www.provet.co.uk/health/diseases/aortic%20stenosis.htm#i
http://www.nlm.nih.gov/medlineplus/ency/article/00178.htm

~Shantz