The treatment plan for your aortic stenosis depends on how severe your condition is.
If your case is mild or moderate, your doctor may decide to keep an eye on how you’re doing for a while. You’ll get regular checkups and echocardiograms. You may hear this called “watchful waiting,” and even if your stenosis is severe, your doctor may recommend it if you have no symptoms.
Your doctor will probably encourage you to make changes to improve your overall heart health. Those shifts might include:
- Tweaking your diet to make it healthier
- Working on weight loss, if needed
- Quitting smoking
- Managing your stress
- Exercising, depending on your symptoms
No pill can cure or even improve your aortic stenosis. But there are some medications that may help you control your symptoms and lower the chance of having certain complications.
Among the medicines your doctor might prescribe are:
- ACE inhibitors, which can open blood vessels more fully
- Medicines that tame heart rhythm problems
- Beta-blockers, which slow your heart rate
- Diuretics (“water pills”), which lessen the amount of fluid in your body and ease stress on your heart
You and your doctor will probably also talk about whether you should take aspirin every day and whether you need to take statins, which are meds that lower your LDL (“bad”) cholesterol. They have some benefits for your overall heart health but -- like all medications -- come with risks as well.
If your aortic stenosis needs more aggressive treatment, you may have choices. Some procedures repair your faulty valve. Others replace it.
Balloon valvuloplasty aims to repair your heart’s faulty valve. The doctor guides a flexible, thin tube tipped with a deflated balloon through a cut in your groin into an artery and up to your heart. Once it’s there, the balloon inflates so that it can stretch the narrowed valve. Then the balloon deflates and comes out, along with the catheter.
The effect doesn’t last forever, so doctors don’t use this procedure very often. It may be best for children, for people who aren’t well enough to have major surgery, or for those who are waiting for another operation.
Sometimes the best option is to remove the faulty valve and replace it. Your replacement valve might be mechanical, or it might be tissue from cows, pigs, or people.
Both choices have advantages and disadvantages. Man-made valves last longer, but you’ll need to take blood-thinning medicines for the rest of your life. Biological valves must be replaced after 10 or 15 years. Your doctor can help you weigh your options.
A newer approach allows you to get a fresh valve without open-heart surgery. It’s called transcatheter aortic valve replacement, or TAVR. It’s a little like balloon valvuloplasty, because it uses a catheter threaded into an artery to your heart. The catheter can go through your groin (your doctor will call this transfemoral) or your chest (transapical).
The catheter carries a deflated balloon and your replacement valve, folded, on the tip. The doctor guides the new valve into place and then inflates the balloon. This opens your replacement valve and makes it fit snugly inside your old, damaged valve. The balloon deflates, then the doctor removes it and the catheter.
Another version of this procedure uses a valve that can expand on its own, making the balloon unnecessary. Doctors also can use TAVR sometimes if you’ve already had valve replacement but the valve has worn out. That’s called a valve-in-valve procedure.
Your doctor might recommend TAVR if your stenosis is severe and open-heart surgery is especially risky for you. It does come with a greater chance of certain complications like stroke. It’s relatively new and still evolving.