Close Get Latest Internet Explorer Get Latest Firefox Get Latest Chrome

Aortic Stenosis


Overview

Aortic stenosis is a condition when the leaflets that make up the aortic valve do not separate fully, causing a blockage of blood flow to the body. This can be a little blockage (mild) or it can be a large blockage (severe). This blockage increases the pumping work of the left ventricle. It may lessen the amount of blood that goes out of the ventricle (lower left chamber) to the body through the aortic valve.

Aortic stenosis can occur on its own, or as part of a group of abnormalities that together effect the left side of the heart. In most cases, aortic valve stenosis occurs before a baby is born. A baby may become symptomatic shortly after birth or if stenosis is mild and causes no symptoms, not until later in life. Rarely, aortic stenosis can develop after rheumatic fever or endocarditis.

Symptoms of aortic stenosis include poor blood flow to the body with pale or grey color, weak pulses and shock. Children with milder cases may tire easily or have to rest during exercise. Some children may faint when not enough blood is reaching the body. In severe cases, sudden cardiac death can occur.

Treatment for aortic stenosis varies widely depending on the severity of the blockage and the symptoms. Some children may need only to be monitored regularly, while others may require a procedure. See more details for treatments below.


Normal heart – in a healthy heart with proper blood flow, the blue droplets representing oxygen-poor blood travel to the lungs, and the red oxygen-rich droplets circulate through the body.

A heart with aortic stenosis has leaflets that do not separate fully, causing a blockage of blood flow.



There are several different types of aortic stenosis.

Valvar aortic stenosis – thick or fused leaflets of the valve.

Subaortic stenosis – a thick area below the valve usually made of muscle. It can also be a membrane of tissue that sticks out in the path of blood below the valve. It does not respond as well to stretching with a balloon and usually needs surgery to open up the narrow area. The abnormal path of blood flow can damage the valve if not repaired.

Supravalvar aorticy stenosis – a narrowing of the blood vessel above the valve. Sometimes the vessel can be stretched with a balloon but other times the vessel is stiff and won’t stretch. If this is true, surgery may be needed to open up the narrow area.



Treatments

Treatment for aortic stenosis varies depending on the severity of the blockage and the symptoms. Children with mild to moderate cases may not need any treatment—they will simply be monitored. Certain steps may be necessary, such as taking antibiotics periodically to prevent and infection inside the heart called bacterial endocarditis . Children with moderate stenosis may be able to be managed with medication to help the heart maintain function, prevent irregular heartbeats (arrhythmias), and control blood pressure. Some children’s activity may be limited.


A heart with aortic stenosis

Balloon valvuloplasty or balloon dilation is the most common procedure used to treat aortic stenosis. The procedure is done by a pediatric interventional cardiologist in the interventional catheterization lab. While the child or baby is sedated, a small, flexible catheter is inserted into a blood vessel. The catheter is guided up into the heart and across the aortic valve. A deflated balloon at the tip of the catheter is inflated once the tube is in place, stretching the narrowed aortic valve open.



Surgical repair or replacement – some children with aortic stenosis will need surgery to repair or in some cases replace their aortic valve. If the valve needs to be replaced, the replacement valve can be either a mechanical or tissue valve. The Intervention for a valve defect depends on the child’s individual situation. We rather not replace a valve in a child with a mechanical valve. Having a mechanical valve requires taking blood thinners, which we try to avoid. Surgery to repair or replace the valve includes:

  • General anesthesia
  • Opening the chest in the center
  • Using cardiopulmonary bypass
  • Opening the aorta to see the valve from above and using this opening to repair or replace the valve

Surgery for valve repair

Surgery for valve replacement

Surgery for subaortic stenosis – subaortic stenosis does not respond as well to stretching with a balloon and usually needs surgery to open up the narrow area. The abnormal path of blood flow can actually damage the valve if not repaired.

Surgery for supravalvar aortic stenosis – when the vessel is s tiff and won’t stretch with a balloon, surgery may be needed to open up the narrow area.

.