Severe Aortic Stenosis
The treatment of choice is aortic balloon valvuloplasty. Intervention is indicated, as our patient is symptomatic and the lesion is severe.
The specific criteria for balloon valvuloplasty, present in this patient include: a critical valve gradient and area, mobile aortic leaflets, and insignificant aortic regurgitation. Most such patients are young.
The risks and complications of balloon valvuloplasty are low, but include significant aortic regurgitation. The procedure is generally safe and effective and the results in terms of symptomatic and hemodynamic improvement are comparable to surgical valvotomy.
After balloon valvuloplasty, some patients may develop progressive aortic regurgitation and others may undergo degenerative valve changes, including calcification with restenosis. These patients may require prosthetic valve replacement.
In older patients with fibrotic and heavily calcified valves, balloon valvuloplasty is frequently unsuccessful or affords only brief palliation of symptoms. Surgery is the treatment of choice in the older patient. For those older patients with an extremely high surgical risk, trans-catheter aortic valve replacement (TAVR) is a reasonable, less invasive intervention. Treatment choice must be individualized.