Is surgery required?

My husband has a bicuspid aortic valve with stenosis. He will have an angiogram Friday. Is there a measurement of the valve which tells us that surgery is absolutely necessary and life threatening not to go ahead or does it depend on symptoms. We are paying privately and so far the doctor has said better to get on with having surgery as it will be needed at some point but we would like to know how long we can wait.

[ed34]

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[kalim123]

Coronary angiogram is being done for the search of a coronary lesion , so that it can be corrected simultaneously with the valve surgery. If your husband has significant stenosis with some symptoms called ASD( Angina, syncope, dyspnoea) then surgery is good choice. If his ejection fraction is reduced as seen in echocardiography report then surgery is must. Recovery of heart in terms of life longevity and improvement in quality of life is best in aortic stenosis disease as compared to other valvular heart diseases.
                                                       I hope you are satisfied , if you want more clarification pl do write.

[Gallery]

Thanks for your response that helps. You may not be able to answer this but any ideas as to how long my husband could reasonably wait before having the operation? He really needs to get his head around it but we knowvthere arevrisks in waiting.

[ed34]

How urgent surgery is, depends on the functionality of the valve itself. There are different stages the valve goes through as it starts to malfunction and leak. What you need, if you haven't already had one, is an Ultrasound scan. This using a doppler technique will establish just how badly the valve is leaking. An Ultrasound report will give a statement for each valve in the heart, i.e. trivial regurgitation, mild, moderate or severe.
If stenosis is the problem, then I think the cardiologist is correct in saying surgery should be performed, but only if it is at the mild stage. If it's still trivial, then there's no need yet. In general, valves were left until moderate/late moderate before surgery but more research is showing that the progression time between moderate and severe can be very short. Then the heart begins to change shape to try and work harder, it enlarges, and this can squash the orifice, where the valve is situated, out of shape. This can be ballooned to get the shape back, but in many cases it collapses again, squashing the new valve so it malfunctions. So generally now, the thought is to perform surgery before the moderate stage. Prognosis with patients who have valve replacement at late mild stage is much higher.
Have you considered whether you are going to have a mechanical valve or tissue?

[kalim123]

ed34 explained it to you in a very good simple way , being a cardiologist this is difficult for me. Yes progression from mod to severe AS is unpredictable , so sooner you get surgery before you get left ventricular dysfunction your risk of surgery is minimal.

[Gallery]

Thanks to you both for your really helpful replies. My husband went in for the angiogram and thankfully his heart muscles are good so the main thing is to have the op done as soon as poss to prevent any further damage. He is going to have the porcine valve on the basis that in 10 to 15 years time surgery should be much improved when it needs replacing.  Can I ask just one more question of you both? We are resident in the UK and here minimally invasive surgery is used only on older patients who are unable to tolerate open heart surgery. Is that the same in the US or is the US more advanced than us such that minimally invasive is used very commonly even on patients who are otherwise fit and healthy?

[ed34]

Sorry I am also UK, but I do believe the rules are the same in the USA.