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Dr. Kereiakes - Heart Valve

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What is aortic valve stenosis?

Aortic valve stenosis (AS) involves thickening and progressive stiffness of the aortic valve, which restricts the normal flow of blood from the main beating chamber of the heart (left ventricle) to the aorta and other body organs.

What are the causes of AS?

Aortic stenosis may be the result of rheumatic fever or a genetic irregularity (bicuspid aortic valve), but typically, the valve tissue becomes scarred and thickened as a result of typical risk factors (high blood pressure, cholesterol, diabetes, etc).

What are the symptoms of AS?

Patients with severe AS may have symptoms of chest pain, fatigue, shortness of breath, lightheadedness, fainting or difficulty when exercising. In general, AS is a slowly progressive disorder which follows a long period without symptoms. Once symptoms occur (progressive shortness of breath, chest discomfort, light-headedness or fainting spells), the need for treatment is urgent. What risk factors contribute to AS? Risk factors for AS are similar to those for atherosclerotic cardiovascular disease and may include increasing age, elevated cholesterol, high blood pressure, diabetes and smoking.

What treatment options are available?

No effective drug therapy exists for aortic stenosis. Valve replacement surgery is the gold standard treatment. This surgery is an open-heart procedure to remove the poorly functioning valve, and replace it with either a mechanical (synthetic/man-made) or a tissue (biologic/usually from a cow or pig) valve. During surgery, the pumping and oxygenation function of the heart is taken over by a heart-lung machine and medications are given that briefly stop the heart. This puts the heart completely at rest while the surgeon performs the valve replacement surgery.

Following surgical valve replacement, most people go on to lead normal, healthy lives. Surgical valve replacement can improve survival and quality of life as well as alleviate symptoms. However, elderly, frail individuals with multiple health concerns may not be candidates for valve replacement surgery.

Balloon aortic valvuloplasty (BAV) offers an alternative when valve surgery cannot be preformed. During BAV, a balloon catheter is inserted via an artery in the leg and passed to the heart to the aortic valve. A balloon is inflated across the aortic valve which stretches the valve and breaks up the calcium in the valve leaflets. The benefit of BAV is usually temporary, lasting six to 12 months before recurrent valve blockage occurs.
New research trial now underway A research trial for transcatheter aortic valve replacement is underway at The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital. Following BAV, a replacement valve is inserted through a catheter without surgery. The investigational Edwards SAPIEN XT valve is modeled after the type of valve used for surgical replacement. (See RetroFlex 3 transfemoral delivery system with expanded valve below.)

The Christ Hospital is available to help in the diagnosis and treatment of valvular heart disease. With options for surgical and minimally-invasive procedures, as well as clinical trials, the hospital offers one of the most comprehensive programs for heart valve disease care in Greater Cincinnati.

 

 

What if I am not a candidate for valve replacement surgery?

Sometimes elderly individuals with multiple health concerns may not be candidates for valve replacement surgery. Balloon aortic valvuloplasty (BAV) offers an alternative when valve surgery cannot be preformed. During BAV, a balloon catheter is inserted via an artery in the leg and passed to the heart to the aortic valve. A balloon is inflated across the aortic valve which stretches the valve and breaks up the calcium in the valve leaflets. The benefit of BAV is usually temporary, lasting six to 12 months before recurrent valve blockage occurs.

New research trial now underway

A research trial for transcatheter aortic valve replacement is underway at The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital. Following BAV, a replacement valve is inserted through a catheter without surgery. The investigational Edwards SAPIEN XT valve is modeled after the type of valve used for surgical replacement.
For more information about this clinical trial, please call 513-585-1777.

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