Severe aortic stenosis with significant symptoms or systolic dysfunction (EF < 50%) should be treated with which intervention?

• A. Medical therapy
• B. Mitral valve replacement
• C. Aortic valve replacement
• D. Pulmonary valve replacement

Answer: (C)

Severe aortic stenosis creates a fixed obstruction to left ventricular outflow, and once symptoms appear or the LV begins to fail (ejection fraction dropping below about 50%), prognosis worsens unless the valve is replaced. Replacing the aortic valve directly removes the obstruction, improves blood flow, and can reverse or halt the progression of LV dysfunction, which is why this is the appropriate treatment. Medical therapy can help manage symptoms or heart failure, but it doesn’t fix the underlying valve narrowing and does not improve survival in severe, symptomatic AS. Replacing other valves or just medical management would not address the root problem here. In modern practice, aortic valve replacement (or transcatheter aortic valve replacement in appropriate patients) is the definitive intervention.