The classification
Aortic valve stenoses are first classified according to their origin, i.e. acquired or congenital (inherited). In inherited aortic stenosis, the localization of the narrowing at the aortic valve must be distinguished: valvular/supravalvular/subvalvular aortic stenosis. The shape of the aortic valve can be unicuspid or bicuspid and refers to the presence of certain heart valve structures.
The cardiac ultrasound examination is used to determine the mean pressure gradient of the aortic valve, the aortic valve opening area and the valvular restiance. These criteria are used to assess aortic valve stenosis into the severity grades. The degrees of severity are graduated into mild, moderate and severe
The treatment
The treatment of aortic valve stenosis depends on the extent of the stenosis. If there is a slight narrowing of the aortic valve, treatment is usually initially conservative. In the case of aortic stenosis, this means that severe physical strain is avoided, and those affected should take it easy.
Endocarditis prophylaxis is also recommended to prevent inflammation of the heart valve. This includes, for example, the administration of antibiotics during (surgical) interventions so that pathogens on the heart valves have no chance. If the aortic stenosis is more pronounced and clinical symptoms are present, surgical therapy is preferred.
There are various surgical methods to treat stenosis. For acquired stenosis, which often occurs in older age, aortic valve replacement is often chosen. There are biological valve prostheses from pig, cattle or horse, and mechanical valve prostheses.
Valves from human cadaver donors are rarely used. An alternative is balloon dilatation of the aortic valve. This method is mainly used in congenital aortic stenosis and is performed with a heart catheter.
In young patients with congenital aortic stenosis, the Ross operation is also performed. In this method, another heart valve (the pulmonary valve) is replaced by a foreign valve and the patient’s own pulmonary valve is used as the new aortic valve. The advantage is that this heart valve grows very well with young patients.
Patients suffering from aortic stenosis and heart failure for which surgery is out of the question receive diuretics and, if necessary, digitalisglycosides. Diuretics should be used with caution and initially in low doses. There are also drugs that are absolutely contraindicated in aortic stenosis and should not be administered.
These include ACE inhibitors, which reduce the so-called afterload on the heart. In the case of aortic stenosis, these drugs would additionally increase the pressure and are therefore strictly prohibited. Calcium antagonists and nitrates are also taboo.
Surgery is possible for aortic valve stenosis as soon as symptoms occur. Clinical symptoms often occur with moderate to severe stenoses. There are various options for patients with aortic valve surgery.
Surgery involves risks and dangers, but these basically depend on the method used and the patient’s circumstances. Additional heart diseases, anaesthetic tolerance and other factors play an important role. Open heart valve operations are suitable for “fit” patients. For patients for whom open surgery seems too risky, balloon dilatation with a heart catheter may be a suitable procedure.
