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Suggest treatment for aortic stenosis with low ejection fraction

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Posted on Wed, 13 May 2015
Question: My mom 87 in July with aortic stenosis valve is .6 on echo and 1.05 on heart XXXXXXX EF is 25% on echo and estimated at 40% on heart XXXXXXX Meant T valve gradient is 35mmHG on both. Other things on cat: Aorta sat 91%, cardiac output is 4.88 Arteris no more than 30% stenosis. Conclusion, non obs CAD, no MV regurgitation. Trying to decide about open heart surgery for AVR. Recently started her on XXXXXXX 12.5 and lisinopril 2.5 and warfarin. She is slightly sob, no LE edema. She also has spondylithisis and burning pain in legs that limit her mobility. All other labs good, non diabetic, non smoker, no renal disease. What do you think about surgery risks.
that is coreg 12.5 mg. Doesn't she have LFLG AS? They did not do a BNP.
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Answered by Dr. Ivo Ditah (42 minutes later)
Brief Answer:
It is not LFLG!

Detailed Answer:
Hi and thank you so much for this query.

I am so sorry about the heart disease that your mom has. In LFLG(Low flow, low gradient aortic stenosis?), the left ventricular ejection fraction is conserved. This is not the case with your mom as she has a lower EF at 25/40%. She is not therefore qualified to be classified as a client with LFLG AS.

Given her age, the risk of surgery is concerning. However, the anesthetist would do this evaluation. With better anesthetic ad surgical procedures, chances are high that she might be able to make it without any major difficulties, The best persons to easy the exact nature of her risk are the surgeon and anesthetist after a complete medical evaluation. Based on her age, the risk is at minimum moderate.

To operate or not depends on the risk/benefits. Beyond the risk associated with anesthesia and surgery, this procedure significantly improve quality of life. If she has no other worries beside what you have mentioned to me, I will recommend that you consider the surgery. Am sure the doctors are also acting in her best interest. But if you think the heart problem is not her major worry at this time, think it over again.

I hope this helps. I wish you well. Thanks for using our services and do feel fee to ask for more information and clarifications if need be.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Ivo Ditah (27 minutes later)
so then, is she in beginning heart failure not due to her AS. She has appt with surgeon in a few weeks. But, I am a nurse and know to well the risks of open heart surgery then possible infection, then defib, then pacemaker blah blah.
doctor
Answered by Dr. Ivo Ditah (15 hours later)
Brief Answer:
AS is a known cause of heart failure!

Detailed Answer:
Hi,

I could tell from your question that you are very familiar with the medical corps. I am happy you know about these possible risks. Everything we do is a risk and only when we look at the potential benefits that we would be able to justify why we take the risk, For this reason, I will like you to focus a little on what she stands to gain from this through you own knowledge and what her doctors say.

If you think her major worries are not related to the heart disease(may be something else like her back pain), decline the surgery. If you think with a more performant heart her quality of life would greatly improve, then go for it.

I cannot say more or make the decision in the clients place. However, weigh the risk and benefits and go with what is more beneficial overall.

I wish you well.
Above answer was peer-reviewed by : Dr. Pradeep Vitta
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Dr. Ivo Ditah

Internal Medicine Specialist

Practicing since :2002

Answered : 3994 Questions

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Suggest treatment for aortic stenosis with low ejection fraction

Brief Answer: It is not LFLG! Detailed Answer: Hi and thank you so much for this query. I am so sorry about the heart disease that your mom has. In LFLG(Low flow, low gradient aortic stenosis?), the left ventricular ejection fraction is conserved. This is not the case with your mom as she has a lower EF at 25/40%. She is not therefore qualified to be classified as a client with LFLG AS. Given her age, the risk of surgery is concerning. However, the anesthetist would do this evaluation. With better anesthetic ad surgical procedures, chances are high that she might be able to make it without any major difficulties, The best persons to easy the exact nature of her risk are the surgeon and anesthetist after a complete medical evaluation. Based on her age, the risk is at minimum moderate. To operate or not depends on the risk/benefits. Beyond the risk associated with anesthesia and surgery, this procedure significantly improve quality of life. If she has no other worries beside what you have mentioned to me, I will recommend that you consider the surgery. Am sure the doctors are also acting in her best interest. But if you think the heart problem is not her major worry at this time, think it over again. I hope this helps. I wish you well. Thanks for using our services and do feel fee to ask for more information and clarifications if need be.