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Doctors' Answers to "Frequently Asked Questions" - Aortic Stenosis

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Aortic Stenosis
Question: I have a 7 year old male with congenital Aortic Stenosis. He had a valvulotomy at age 3. He has some degree of aortic insufficiency and left ventricular hypertrophy and takes Digoxin. When is the best time to have the valve surgery? Now, or when the child becomes symptomatic? How long do those valves last? What is the prognosis?

Answer: The timing of the surgery is difficult. In general, we try to get as much mileage out of the original equipment as possible. However, we do no desire that there is permanent damage to the heart muscle by delay. In general, children are put off, if possible, since delay will minimize the number of operations needed over their lifetime. Each repeat operation is more difficult due to scar tissue, etc., and the valves have a finite lifetime. Also, the childís heart enlarges with growth and a valve put in at age 3 will be insufficient by age 14 in most cases . Aortic stenosis is one of the more difficult problems to give advice on since it is very dependent on several factors including the gradient of pressure across the heart, the change in muscle thickness, etc. The prognosis in simple aortic stenosis is very good, but may require multiple surgeries.

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