COPD and Aortic Stenosis

[kiba]

My 82 yearl old father was diagnosed in November with COPD and aortic stenosis.  In May he had an aortic valvupasty that doubled the size of his aortic valve.  The original size was 4.  

He is a candidate for aortic valve replacement.  At this time any physical activity causes him to have shortness of breath for 2 to 3 minutes.  He is on oxygen 24/7. His base oxygen level is 3 lpm.  Resting his oxygen saturation is in the 90's but any physical activity drops the saturation into the 70's range.

Would replacing the aortic valve help him be able to breathe more freely when doing activity? His pulmonary doctor says his lungs are as good as they are going to get.  I would like to know that there would be a benefit gained from having him go through the heart surgery.  My dad thinks that if he has the surgery the shortness of breath will go away and he may even be able to come off of oxygen.  Is that realistic?

[National Jewish Health]

This question would best be answered by a discussion between your father’s cardiologist and his pulmonary doctor, regarding the relative contributions to his shortness of breath with exertion of, 1) the aortic stenosis and, 2) the COPD.  The dramatic fall in oxygen saturation with (presumably) minimal physical activity, unless attributable to (a right to left) shunt within his heart or due to chronic lung congestion secondary to the aortic stenosis, is on the basis of his lung disease and indicative of severe, advanced lung disease.  If due to his intrinsic lung disease, surgery would pose a considerable risk and would not, even with successful valve surgery,  relieve his low oxygen levels and the limit on physical activity caused by it.  If on the other hand, the fall in oxygen levels is secondary to lung congestion and would likely be relieved by an open aortic valve, it is conceivable that his shortness of breath would be relieved somewhat and his need for supplemental oxygen reduced but probably not entirely eliminated.  Your father’s hope for this and relief of shortness of breath, in this scenario, would not be entirely unrealistic.

Once the two specialists have estimated the relative contributions of lungs and heart, if they determine that relief of the aortic obstruction would be likely to provide clinical benefit, they should then seek to determine the risk of the surgery, at the time, and in the post-operative period.  Factors to be included in any estimation of risk – the severity of his emphysema and his general health, including whether he would be considered an old 82 or a young 82 year old man.