Aortic Stenosis in Children
Aortic stenosis means that your child has a heart valve that is too narrow or is
blocked. The aortic valve is 1 of 4 heart valves that keep blood flowing through the
heart. The valves make sure blood flows in only one direction. The aortic valve keeps
blood flowing from the left ventricle to the aorta. Your child may be born with aortic
stenosis (congenital). Or it may happen later (acquired). It occurs more often in
than in girls.
normal aortic valve has 3 cusps (leaflets) that act as a one-way door. With aortic
stenosis, the valve doesn’t work as it should or has an abnormal number of leaflets
don't work correctly. That makes it harder for the leaflets to open and let blood
from the left ventricle to the aorta.
Aortic stenosis may be mild, moderate, or severe. It depends on how much of the blood
is blocked. The condition may get worse over time. It may also occur with other heart
problems or conditions.
Moderate to severe aortic stenosis may affect the heart and blood vessels in these
time, the left ventricle becomes larger and can’t pump blood to the body very
aorta may also become larger.
- The coronary arteries that send blood to the heart muscle may not get enough blood.
A child can be born with aortic stenosis. This means the aortic valve didn’t form
as it should before birth. Sometimes this problem is caused by a genetic problem.
But most of the time, the cause for this isn’t known. In older children, aortic stenosis
may occur after an untreated strep infection.
symptoms of aortic stenosis vary depending on how old your child is. They also vary
how severe the blockage is. For example, a child with mild aortic stenosis may have
symptoms. Or they may not have any symptoms. Symptoms may not show up until adulthood.
Or a baby may have trouble feeding and may not gain weight. With severe (critical)
aortic stenosis, a baby is very ill.
Severe aortic stenosis may cause:
- Fatigue or tiredness
- Bluish discoloration around the lips or skin indicating low oxygen levels (cyanosis)
enough weight gain
- Dizziness or lightheadedness, especially with physical activity
- Fainting (syncope)
- Shortness of breath or rapid breathing
- Irregular heartbeats or feeling the heart beat (palpitations)
- Chest pain or pressure
symptoms of aortic stenosis can be like other health conditions. Make sure your child
sees their healthcare provider for a diagnosis.
Your child's healthcare provider may have heard a heart murmur when listening to your
child’s chest with a stethoscope. A heart murmur is an abnormal sound as blood moves
through the heart. A heart murmur may mean that your child has a heart defect. Your
child’s symptoms are also part of figuring out the diagnosis.
child may need to see a pediatric cardiologist to confirm the diagnosis. This is a
doctor with special training to treat heart defects and other heart problems in
children. Your child may also have tests such as:
Chest X-ray. This gives an overall picture
of your child's heart and lungs.
Electrocardiogram (ECG). This test measures
the electrical activity of the heart.
Echocardiogram (Echo). This test uses sound
waves to give a moving picture of the heart and valves. This is one of the best
tests for aortic stenosis.
Cardiac catheterization. This test shows
details of the structures of the heart. Your child will have this test while asleep.
The doctor will put a thin, flexible tube (catheter) into one of your child’s blood
vessels. The doctor will slowly guide the catheter to the heart. Contrast dye may
injected to let the cardiologist see more detail.
Exercise testing. This allows the doctor to
examine the child's ECG during exercise.
Pulse oximetry. This noninvasive test
measures oxygen levels in the blood through a sensor placed on your child's
Treatment will depend on your child’s symptoms, age, and general health. It will also
depend on how severe the condition is. If your child doesn’t have symptoms, or if
symptoms are mild, their healthcare provider may just watch symptoms closely. This
your child may often need office visits and tests.
pediatric cardiologist and a cardiothoracic surgeon will figure out if your child
an aortic valve procedure. The procedures include:
Balloon aortic valvuloplasty. This is done with cardiac catheterization using a catheter with a deflated
balloon in the tip. The catheter is put into a blood vessel. It is moved to the
narrowed valve, and the balloon is inflated to open the valve. Many providers prefer
Surgical aortic valvotomy. This is surgery
to remove scar tissue from the aortic valve leaflets. This lets the leaflets open
Aortic valve replacement. This is surgery to replace the aortic valve with a new valve. Replacement valves
are either artificial or from donor organs or animals.
Pulmonary autograft (Ross procedure). This
is surgery to replace the aortic valve and part of the aorta. Your child's own
pulmonary valve and part of the pulmonary artery are used to replace the damaged
aortic valve. A pulmonary valve and part of the pulmonary artery from a donor organ
are used to replace the transplanted valve and artery. Many surgeons prefer this
method because it continues to work well as a child grows.
Before the procedures:
- A baby
who has critical aortic stenosis will be in an intensive care unit (ICU). They may
need emergency repair of the valve. Babies who aren’t as sick can have the procedure
- A child
with severe aortic stenosis may not be able to take part in sports. This is more a
risk with sports that have intense or long periods of activity.
Possible complications of moderate to severe aortic stenosis include:
or weakening (aneurysm) of the aorta
(dissection) of the aorta
- Infection of the lining of the heart, valves, or blood vessels (infective
- Enlargement of the heart chambers (hypertrophy)
- Heart is
not able to pump as it should (heart failure)
with your child’s healthcare provider about their risk for these problems.
Congenital aortic stenosis can’t be prevented. But all newborns are screened for
congenital heart disease with pulse oximetry. This is a simple, painless test to check
the amount of oxygen in the blood. It’s done by placing a small probe on the baby’s
and leg. If the oxygen level is low, it may mean there is a heart defect. More testing
and treatment will be done if a problem is found.
children who have had an aortic valve repair or replacement live active, healthy lives.
Your child’s activity levels, appetite, and growth usually return to normal. Your
should get regular follow-up care with a cardiologist throughout their life. Your
may also need:
and management of high blood pressure. Be sure to have your
child take all medicines prescribed by their healthcare provider.
This is to prevent infections that may lead to a heart infection
Talk with your child’s healthcare provider about safe
activities for your child.
This includes dental work. This depends on whether your
child has had a valve repair or replacement.
These prevent blood clots from forming on a
mechanical valve. Blood tests to check the blood thinners are also done.
repeat valve repair
Talk with your child's healthcare
provider about what sports activities are safe.
When to Call a Healthcare Provider
Contact your child’s healthcare provider if you notice:
- Symptoms such as chest pain or trouble breathing that get worse
- Dizziness or tiredness with physical activity
you child has had a procedure, make sure to follow all instructions from the
surgeon. And make sure to keep all follow-up appointments with your child’s cardiologist
stenosis means that a valve in your child’s heart is too narrow or is blocked. This
condition can be mild, moderate, or severe.
symptoms are tiredness, trouble feeding and not enough weight gain, dizziness,
shortness of breath, chest pain or discomfort, and a fast heartbeat.
- A pediatric cardiologist usually diagnoses and manages aortic stenosis.
- Several procedures are available to repair or replace the aortic valve.
- First-degree relatives of your child should talk with their healthcare providers
about the need for screening for aortic stenosis.
- A child
with aortic stenosis should be checked often. Follow-up care is needed throughout
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the
visit, write down the name of a new diagnosis and any new medicines, treatments, or
tests. Also write down any new instructions your provider gives you for your
- Know why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
- Know how you can contact your child’s provider after office hours. This is important
if your child becomes ill and you have questions or need advice.