Valve stenosis must be severe and symptomatic before surgery is considered

Ask Dr. Keith Roach M.D

Valve stenosis must be severe and symptomatic before surgery is considered

DEAR DR. ROACH: I am 87 and in fairly good health, except for some well-controlled high blood pressure and greater-than-average atherosclerosis. A recent catheterization of my heart revealed a 90 percent blockage of a large artery, requiring a stent. It also revealed stenosis of the aortic valve. The opening to the artery is only 1.3 cm, compared with a normal opening of around 3.33.5 cm. The mean gradient is 10 mm Hg. Since getting the artery stent, I am doing cardiac rehab with no symptoms, and my cardiologist said that my heart function is normal, with an ejection fraction of 65 percent.

My cardiologist thinks it is risky at my age to replace the valve and thinks that with proper lifestyle behavior, I can keep the stenosis from worsening.

My question is how dangerous is the small size of the valve opening compared with the risk of an operation to replace the aortic valve? -R.P.

ANSWER: The decision to replace a valve needs to take a great deal into consideration, especially the symptoms a person is having, how severe the stenosis (narrowing) of the valve is and the overall surgical risk for the person. Someone with symptoms, severe stenosis and an otherwise low risk for surgery is the best candidate for surgery.

In your case, you have no symptoms, the narrowing of the valve is not very severe and your heart function is normal. 'Severe' stenosis would be represented by a valve area of less than 1 or a mean gradient of greater than 40. A normal ejection fraction is between 50 and 75 percent.

Heart surgeons do operate on people in their 80s, but the mortality risk is twice what it would be if you were 10 years younger. I used an online calculator, which estimated your risk for death or a severe complication during surgery at 14 percent. Given that, I agree with your cardiologist that surgery is not required nor recommended. This decision needs to be re-evaluated if you develop symptoms, and you should have periodic visits to check on the valve's anatomy.

Although there are no proven medical therapies to prevent the stenosis from worsening, the treatments that are appropriate for someone with blockages in the arteries may help with the valve disease as well. Good control of blood pressure, especially with an ACE inhibitor or ARB, will reduce the likelihood of complications from aortic stenosis.

DEAR DR. ROACH: My 5year-old grandson loves monster trucks. A talented relative made him a monster truck bed with real rubber wheels. Every time I go into his bedroom, there is a strong smell of rubber, even after more than a year with the bed. I worry about the child sleeping and playing there, with the odor permeating his environment. Should I be concerned about this strong odor? — G.E.

ANSWER: Natural rubber causes allergic reactions in some people, but if he is having no symptoms, the consensus of the sources I read is that there is likely no health impact from the odors of natural rubber. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.co rnell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall. com.