Balloon Valvuloplasty for Aortic Valve Stenosis

[Miriam__0]

  You have been very helpful to me in regard to my father's case and I have one more question to ask.  My father, 86, is in the hospital with heart failure awaiting the opportunity to have open heart surgery to replace his aortic valve.  The delay is due to the fact they are unable to find the cause of his anemia, which continues to be a problem.  He had had a blood transfusion 2 weeks ago and got his hemoglobin up to 10.7 and it's now down to 8.5 and he had to have another blood transfusion yesterday.  The cardiologist is concerned that there may be bleeding but the internist has arranged for every test known to man and found none.  He has suggested there may be hemolysis due to damage caused by the narrow heart valve which sounds logical since my father never had anemia until the valve condition worsened.
  My father's condition is declining while they continue to be concerned about this anemia.  Is there an alternative to the valve replacement that could buy him time until they find the cause of the anemia?  I'm concerned that he is not as good a surgical risk as he was before, due to this long delay.  Would balloon valvuloplasty be a good interim step to enable his health to improve in order to withstand the open heart surgery?  For that matter, would it be worth the risk to just go ahead with the valve replacement under the hope that the anemia is not being caused by bleeding rather than waiting until the whole thing becomes a moot point because my father dies?  Any help you can provide would be greatly appreciated.

[CCF CARDIO MD APS]

_
Dear Miriam,
Your summary of your father's condition, the situation you and his doctors face,
and your question are very thorough and get right to the point.  As a matter of
fact you answered the question yourself, a balloon vavuloplasty is used in some
cases of aortic surgery in order to buy time prior to surgery to replace the
valve.  The risks for things like stroke, heart attack, and such are very much still
a consideration with vavuloplasty and therefore the risks of this temporizing
procedure must be weighed against the risk of waiting for the health to improve
prior to surgery (this is determined by his doctors but should be presented to
you and your father.)  As it sounds, your father's anemia may very well be due to
the abnormality of the valve itself and although the valvuloplasty could make the
aortic regurgitation (leak of the valve) worse, I suppose it could potentially
relieve the shear forces of the stenosis long enough to lessen the anemia (if this is
the cause.)  Now you need to know the risks of just going ahead with the surgery
as this is a possibility from what you have said, however it probably would require
a lot of transfusions and if the anemia did not recover with the new valve in place
it would not only raise his perioperative mortality (chance of death), it would surely
likely be a long rocky post operative course for your father.  You should also know
that anemia and stenosis of the aortic valve can cause heart failure, however neither
is well tolerated when a patient is recovering from open heart surgery.  
Probably the next best step for you and your father would be to sit down and have
each option written down and then under each option have the risks for death and
major morbidity (such as stoke) listed; present this to the physicians so that you
and they are on the same page as to what really is an option and in the best
interest of your father's health.  Remember that in some cases the aortic
vavuloplasty is an appropriate temporizing measure or procedure that bridges the
patient to surgical replacement.  Good Luck.
Information provided in the heart forum is intended for general medical informational purposes only,
actual diagnosis and treatment can only be made by your physician(s).