Aortic stenosis prevention
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Mohammed A. Sbeih, M.D. [2]
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Aortic Stenosis Microchapters |
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Diagnosis |
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Treatment |
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Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty |
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Transcatheter Aortic Valve Replacement (TAVR) |
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Case Studies |
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Aortic stenosis prevention On the Web |
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American Roentgen Ray Society Images of Aortic stenosis prevention |
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Risk calculators and risk factors for Aortic stenosis prevention |
Overview
Aortic stenosis associated with rheumatic heart disease can be minimized with antibiotic therapy in patients with documented streptococcal pharyngitis (strep throat). Bicuspid aortic valve disease is a congenital variant and cannot be prevented. Calcific degeneration of the valve can potentially be minimized by rosouvistatin and other measures targeting atherosclerosis prevention.
Prevention
Early antibiotic treatment of streptococcal pharyngitis prevents rheumatic fever and the development of aortic stenosis later in life [1].
The incidence of rheumatic fever decreased before introduction of antibiotics, suggesting that other factors are involved [1].
Precautions
People with aortic stenosis of any aetiology are at risk for the development of infection of their stenosed valve, i.e. infective endocarditis. To lessen the chance of developing that serious complication, people with AS are usually advised to take antibiotic prophylaxis around the time of certain dental/medical/surgical procedures. Such procedures may include dental extraction, deep scaling of the teeth, gum surgery, dental implants, treatment of esophageal varices, dilation of esophageal strictures, gastrointestinal surgery where the intestinal mucosa will be disrupted, prostate surgery, urethral stricture dilation, and cystoscopy. Note that routine upper and lower GI endoscopy (i.e. gastroscopy and colonoscopy), with or without biopsy, are not usually considered indications for antibiotic prophylaxis.
Not withstanding the foregoing, the American Heart Association has recently changed its recommendations regarding antibiotic prophylaxis for endocarditis. Specifically, as of 2007, it is recommended that such prophylaxis be limited only to:
- Those with prosthetic heart valves.
- Those with previous episode(s) of endocarditis.
- Those with certain types of congenital heart disease [2].
Patients with severe AS (< 1.0 cm2) should avoid strenuous physical activity.
References
- ↑ 1.0 1.1 Dajani A, Taubert K, Ferrieri P, Peter G, Shulman S (1995). "Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Heart Association". Pediatrics. 96 (4 Pt 1): 758–64. PMID 7567345.
- ↑ http://www.americanheart.org/presenter.jhtml?identifier=4436