Treatment of Choice
The treatment of choice is valve replacement, as our patient is symptomatic and the lesion is severe. Factors that reduce the risk of surgery include our patient’s age, well preserved ventricular function, and the absence of additional pathology.
Prosthetic Valve Complications
Prosthetic valve replacement must be undertaken with the full recognition of the natural history and the complications that may occur after the procedure. In effect, one may be changing one disease for another. Problems such as valve dysfunction and deterioration, paravalvular leak, infective endocarditis, thromboembolism, and bleeding that may occur when anticoagulants are used, must be considered.
Prosthetic Heart Valves
Aortic valve prostheses fall into two general categories:
mechanical and
tissue. Mechanical valves tend to last longer, but uniformly require anticoagulation. Valves made from biologic tissue usually do not require long-term anticoagulation, but are more vulnerable to tissue degeneration and the consequent need for repeat valve replacement.
Mechanical Prosthesis
In our patient, the use of a mechanical prosthesis with its long-term durability is favored, because of his young age. This type of valve requires anticoagulation. Because he had no known contraindications to this treatment, a mechanical prosthesis was advised.