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This is a narrowing between the left ventricle and the aorta. The commonest is valvar stenosis where the leaflets which are normally thin become thick and have restricted opening. This increases the work of the left ventricle. Severity is variable and even very significant obstruction can cause no symptoms. Complaints of fainting and breathlessness may occur and need assessment. Moderate and severe obstruction require avoidance of competitive sport, rowing, judo and karate. ECG and echo Doppler are very helpful in assessing severity and monitoring change.
Relief of obstruction is required for significant stenosis. The options vary between different hospitals. Some will offer balloon dilatation with a catheter technique as the first treatment, others will offer surgery using the heart lung machine. There is clearly no answer that suits every patient. If a balloon technique is used, we would expect to be able to lessen the obstruction.
Occasionally no benefit happens and other times, the valve leaks significantly afterwards. If the operation is chosen, this is open heart surgery using a heart lung machine. The valve is inspected, stretched and often thinned. Very occasionally, it would need to be replaced at the first operation. Either surgical stretching – or balloon stretching ¬improves the valve but it is likely to thicken again over the years ahead, requiring long¬ term follow-up, and probably, further procedures.
With subvalvar aortic stenosis, a ‘shelf’ occurs between the left ventricle and the aortic valve. This requires ‘open heart’ surgery to remove it when the obstruction is severe. With supravalvar stenosis there is a waist above the aortic valve and above the coronary arteries If the obstruction is severe then this needs to be patched, again using ‘open heart’ surgery.