Aortic stenosis is one of the most common and serious heart valve diseases in which a narrowing of the aortic valve opening occurs. It can occur in adults during aging, but also in children because of a congenital heart defect known as a bicuspid aortic valve.
About Aortic Stenosis
In the upper chamber of the heart, the aortic valve connects the heart to the aorta (the major blood vessel that takes blood from the heart to the rest of the body) and opens and shuts to allow blood to flow. Aortic stenosis is diagnosed when the aortic valve is too narrow or can’t fully open and restricts the amount of blood that can pass through. To compensate, the left ventricle works harder to pump blood through the smaller valve. As a result, the ventricle can thicken and become enlarged. In children, the characteristic narrowing of the aortic valve can be caused by a genetic condition, rheumatic fever, or congenital heart disease. In older adults, deposits of calcium on the valve’s leaflets can alter the valve’s function.
Children who have aortic stenosis have a higher chance of experiencing an infection in the lining of the heart, a swollen aorta that can increase the risk of an aneurysm or a tear in the aorta, and a lack of oxygenated blood in the coronary arteries. Without treatment, the left ventricle may deteriorate and the child may suffer congestive heart failure. Although aortic stenosis can become serious, early diagnosis and treatment to repair or replace the valve can help your child enjoy a full life.
Symptoms of Aortic Stenosis
The best way to prevent aortic stenosis caused by external factors is to pay close attention to your child’s health, especially if your child has a strep infection that evolves into rheumatic fever. Congenital aortic stenosis is also more likely to occur in males than females. Children with mild or moderate aortic stenosis may not have any symptoms. Babies who have aortic stenosis may have trouble feeding or poor growth.
Severe or critical aortic stenosis symptoms in older children may include:
- A bluish color at the lips or fingers
- Chest pain
- Dizziness with exertion
- Irregular heartbeats or palpitations
- Low blood pressure
- Passing out
- Shortness of breath
- Tiring easily during exercise
Diagnosing Aortic Stenosis
During physical examinations, your child’s doctor checks for a heart murmur, which are extra sounds heard throughout the cardiac cycle due to increased blood flow. If your pediatrician suspects obstructed blood flow, a recommendation to see a pediatric cardiologist may be made.
Tests performed when diagnosing aortic stenosis may include:
- Cardiac Catheterization: During cardiac catheterization, a small catheter (thin tube) is inserted into a larger blood vessel, typically in the groin, and guided to the heart where blood pressure and oxygen measurements can be taken in the aorta and pulmonary artery as well as the four chambers of the heart. A dye can also be injected through the tube to make the heart’s structure more visible on an X-ray.
- Cardiac MRI or CT Scan: A cardiac MRI or CT scan is used to take more detailed images of the heart to help define the anatomy and detect anomalies.
- Chest X-Ray: A chest X-ray produces an image of the tissue and bones in the heart and lungs and helps your provider assess the shape, size, and structure of the heart and lungs as well as the aeration of or any congestion in the lungs.
- Echocardiogram: An echocardiogram uses ultrasound technology to create a moving image of the heart and its valves, allowing your provider to assess the structure and function of the heart. An echocardiogram also helps provide information about blood flow and how well the heart is pumping blood
- Electrocardiogram (ECG or EKG): An electrocardiogram uses electrodes that are placed on the body to record the electrical activity taking place in the heart. An ECG/EKG test helps detect abnormal rhythms, such as cardiac arrhythmias, stress on the heart, and damage to the heart muscles.
Treating Aortic Stenosis
Treatment plans can vary based on your child’s age, health, and medical history as well as the level of aortic stenosis and the prognosis. Mild to moderate aortic stenosis typically does not require treatment but should be monitored through regular visits with a cardiologist to ensure the condition doesn’t worsen or begin to affect the heart. Severe to critical aortic stenosis can be treated first with medication to help improve function until a valve repair or replacement surgery can be scheduled.
Treatment options for coarctation of the aorta may include:
- Balloon Valvuloplasty: Using the cardiac catheterization method, a small tube can be inserted through a blood vessel in the groin and guided to the heart. A balloon can be pushed through the tube and inflated in the aortic valve to stretch the narrow portion. A stent may be added after the balloon is removed to ensure the aorta stays open.
- Valve Replacement: The aortic valve can be surgically replaced with a biological valve made from animal tissue or a mechanical valve. The pulmonary valve and a portion of the pulmonary artery from the child (Ross procedure) or an aortic valve from a donor can also be used to replace the valve and part of the aorta.
- Valvotomy: The aortic valve can be opened directly by incising into it.
After treatment, your child will need time to rest and recuperate at home, and activities may be limited. Once your pediatric cardiologist approves, your child should be able to resume normal activities. Follow-up treatment may be needed as your child grows, and ongoing medication may be recommended to prevent blood clots from attaching to artificial valves.
Care Team Approach
The Texas Center for Pediatric and Congenital Heart Disease, a clinical partnership between Dell Children’s Medical Center and UT Health Austin, takes a multidisciplinary approach to your child’s care. This means your child and your family will benefit from the expertise of multiple specialists across a variety of disciplines. Your care team will include pediatric cardiologists, cardiothoracic surgeons, interventional cardiologists, critical care specialists, hospitalists, anesthesiologists, perfusionists, nurses, advanced practice providers, social workers, psychologists, child life specialists, dietitians, physical and occupational therapists, pharmacists, and more, who work together to provide unparalleled care for patients every step of the way. We collaborate with our colleagues at the Dell Medical School and The University of Texas at Austin to utilize the latest research, diagnostic, and treatment techniques, allowing us to identify new therapies to improve treatment outcomes. We are committed to communicating and coordinating your care with your other healthcare providers to ensure that we are providing you with comprehensive, whole-person care.