Questions posted in the Heart Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: Aortic Valve Stenosis

Forum: The Heart Forum
Topic: Stenosis


My 73 y/o father has been diagnosed with aortic valve stenosis, diagnosed by cardiac ultrasound. His cardiologist has informed him that surgery will be necessary. He currently has no other symptoms. The AVS diagnosis occurred April 1998. He has a follow up visit early August 1998. I have several questions:

1. Is cardiac ultrasound generally the test of choice to diagnose AVS,
or should another test, i.e., heart cath., be done to further evaluate
and confirm this condition before surgery?
2. How soon might he require surgery with the diagnosis being made
in April (again, he has no other symptoms currently)?
3. Does his condition need to worsen before the surgery will be done,
perhaps for insurance/reimbursement purposes? Or, can this surgery
be done when the timing is right for Dad and his kids so proper
arrangements can be made for his recovery, etc.?
4. I've heard a bit about "keyhole" surgery for certain types of heart
surgery. I liken this to arthroscopic surgery of the knee in that it is
less invasive and a major chest surgical opening is not required. Is this
type of surgery possible for aortic valve replacement?
5. Lastly, my father lives in Clearwater, Florida, and would have such
surgery within the Morton Plant health system. Is this type of surgery
common enough for your average hospital? If you're familiar with the
Morton Plant health system, would you be comfortable with a loved
one having such a procedure there?

Thank you very much for your time. ________

Dear Paul,
1) Echocardiography is now considered the absolute best way to assess the degree of stenosis of the aortic valve and this is because of the advent of doppler ultrasound.
A cardiac catheterization is necessary pre-operatively in your father only because it will be neccessary to make sure that he has no concomitant coronary artery disease,
this is routinely performed on any patient >40 yo who is undergoing valve surgery. The reason for this
is that should the patient also need bypass of coronary blockages, it should all be done at the same chest opening or time so to speak.
Most centers will at least try to confirm the diagnosis with catheter measurements during the the cath in order to assess the severity of the aortic stenosis, however in the
case of a patient that has a good echocardiogram, it is not neccesary and obtaining measurements at cath should be performed only without putting the patient at further risk.
2)and 3) the decision of timing is a difficult but not impossible and is highly
related to symptoms and the left ventricular function(as seen on echo). The valve should also be replaced based on when the it is best for the patient such that at the time of
surgery he is at the least risk he can be for undergoing major surgery as well at a time when he is most likely to recover quickly.
The decision to go to surgery is a medical decision, not an insurance related one.
4)The smaller incision type surgery you speak of is certainly not keyhole nor like orthoscopic surgery. This is generally termed Minimally Invasive Surgery and
of course it is reserved for valve only procedures (as opposed to valve and bypass), is certainly not performed in many centers.
5) I will have to get back to you on this question as I am not familiar with the above said health plan nor am I familiar with a center near Clearwater that
specializes in valve replacement-which is the type of center I would absolutely require for my loved one if he/she required valve surgery. Surely the general rule in life applies
in such cases and that is that practice makes perfect, so the more valves a surgeon has performed the more likely he/she is to skilled at that particular surgery. Good Luck.
Information provided in the heart forum is intended for general medical informatioal purposes only, actual diagnosis and treatment can only be made by your physician(s).

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