greeneyes,

Thanks for your question.  You asked a similar question on September 15^th.  I will include my answer from that question, as well as an addendum addressing the additional information in this question.

                Monday, September 15, 2008            Martin Cane, M.D.

                greeneyes08,

                Thanks for your question. 

                Stents are devices that are used in the treatment of coronary artery     disease, as well as arterial blockages in other parts of the body.

                There are several options for treating aortic valve disease, and the choice is dependent on the type of problem as well as the patient's condition. 

                If the valve is narrowed (stenotic) then repair is one of two options.  The first is to replace the valve with either a mechanical device or a tissue valve from a pig or cow.  There are advantages and disadvantages to both types of replacement, and again, the individual situation often dictates the procedure.  The second option is to perform a balloon valvuloplasty, also known as a valvotomy.  This procedure employs a balloon that is placed through the narrowed valve and then inflated, thereby widening the opening of the valve.  This is the favored procedure in adolescents with congenital valve disorders, but is done less commonly in adults.  This procedure can avoid the major surgery of replacement, but does not last as long.  Many patients who undergo valvuloplasty eventually require surgery to replace the valve.  However, if surgery is  not possible, but intervention is needed for survival, this is an option.   

                If the valve is leaking, then other procedures are available to correct the problem.  Valves can be repaired or modified surgically in cases of ruptured leaflets (small pouches that work together to seal the valve) and valves that are congenitally abnormal (bicuspid valves - 2 leaflets instead of the normal three).  In some cases this can be done through catheters instead of open heart surgery. 

                A patient will have to discuss all options with the cardiologist and surgeon, weighing the advantages and disadvantages of them all. 

                I hope this has been helpful.

                Martin Cane, M.D.

Because of your previous aortic valve replacement with a prosthetic (artificial, mechanical) valve, the only way to fix the valve is open heart surgery again.  Most likely, the valve will need to be replaced.  Unfortunately, stents have no present use in this situation. I'm sure the prospect of having major surgery again is terrifying, but you should know that having an artificial valve that has functioned for thirty years is quite an accomplishment.  With newer surgical techniques, I'm hopeful that surgery, should that be the decision, will go well and you have as much success with this result as you did with your last surgery.

Best wishes.

Martin Cane, M.D.