Aortal Stenosis

[Janice__0]

  My father is a 77 yr man who has 2 previous bypass surgeries. Most recent was in 1984. For about the last year he has had angina and was admitted to the hospital last march and again in december. In december it appears he suffered a mild heart attack. In march a catherization was done which indicated aortic stenosis which was not considered severe. In October he had a stress test which he was told he passed.  Then about two weeks ago after gradually progessive and severe angina he admitted himself to the hospital. No further tests were done except for blood work and ekg. We were told he may have suffered a mild heart attack and that he has severe aortic stenosis and requires a valve replacement.  We are upset that this was not diagnosed sooner as all the tests were done prior to his hospitalization.  
  My father is very reluctant to undergo a third open-heart surgery. He is an insulin dependent diabetic and we are concerned about his ability to recover from a surgery of this type. Are there other non-surgical methods to treat this disease?  I have heard of something I think called key-hole surgery or balloon valvuplasty, what are those methods? Finally, at his age and given his history, how do the benefits of surgery weigh agianst the risks staistically?  Also, my dad has obtained info about CCF and he is considering obtaining 2nd opinion there, he lives in the north miami area.
  Thanks for your help.

[CCF Cardio MD - MTR]

Dear Janice, thank you for your question.  Your father's situation certainly is complicated.  I can't comment on the progressive in severity of aortic stenosis without knowing the precise results of his prior echocardiograms and catheterizations.  I wonder if some of his bypass grafts from the last bypass surgery are closed and how that interacts with the aortic stenosis to cause his current symptoms.  I understand your and your father's reluctance to consider a third open heart surgery, but there are no other options if he does have severe aortic stenosis.  Balloon valvuloplasty for aortic stenosis is only used as a temporizing measure before definitive surgical correction because the aortic stenosis quickly recurs after this procedure.  Valvuloplasty has a role in congenital aortic stenosis in young adults, but this is a very different disease than aortic stenosis in elderly patients.  I can't accurately assess your father's risks of surgery without knowing more of his medical history, but it appears that he is incapacitated from his symptoms now and may be having multiple small heart attacks.  If this is the case, then I think it's at least worthwhile for him to be evaluated for surgery here at the Cleveland Clinic.  Our surgeons are very experienced at redo open heart surgery, although minimally invasive surgery (keyhole) is reserved for first-time surgery since scar tissue prevents a keyhole approach for a  redo surgery.  To have your father evaluated here, call the number listed below and ask for an appointment with a cardiologist at Desk F-25.  If he decides to come to Cleveland, then please bring copies of his most recent cardiac catheterization films, echocardiograms, and medical records.  
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart
Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.