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Definition
The aortic valve is located between the left ventricle of the heart and the aorta (the largest artery in the body). Aortic stenosis (AS) is a narrowing of the aortic valve. This narrowing could obstruct or block blood flow from the heart. It could also cause a back-up of flow (and pressure) in the heart and to the lungs. AS can range from mild to severe. In children, it is most often a congenital disorder. This means that the child is born with the condition. It may be due to genetic problems, environment, or chance.
Causes
In babies, AS is caused by a birth defect of the aortic valve that may result in:
- One cusp instead of three—When the heart valve is closed, the cusp seals the area.
- Two cusps that are damaged
- Cusps that are partly closed or do not open correctly due to thickness
Damage to the aortic valve can also be caused by certain conditions, like these infections:
- Rheumatic fever (usually occurring after a Streptococcus infection)
- Bacterial endocarditis
Risk Factors
These factors increase your child's chance of developing AS:
- Family members with congenital heart disease that affects valves
- History of rheumatic fever or bacterial endocarditis
Tell the doctor if your child has any of these risk factors.
Symptoms
If your child has AS, he may not have any symptoms. As your child ages, he may develop symptoms, such as:
- Extreme fatigue after exercise or exertion
- Fainting with exercise or exertion
- Pain, squeezing, pressure, or tightness of the chest, usually occurring with exertion
- Sensation of rapid or irregular heartbeat (palpitations)
- Shortness of breath
- Dizziness with exertion
In rare cases, AS can cause:
- Abnormal heart rhythms ( arrhythmia )
- Sudden death with no previous symptoms
Diagnosis
The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. The doctor may be alerted of AS by the following:
- Abnormal chest sounds, such as a heart murmur or click
- Noticeable chest heave or vibration when the doctor's hand is held over your child’s heart
To confirm the diagnosis, tests may include:
- Chest x-ray —a test that uses radiation to take pictures of structures inside the chest
- Electrocardiogram (ECG, EKG)—a test that records the heart's activity by measuring electrical currents through the heart muscle; may show signs of heart strain or enlargement
- Echocardiogram —a test that uses sound waves (ultrasound) to examine the size, shape, and motion of the heart
- Exercise stress test —the recording of the heart during exercise
- Cardiac catheterization (rarely done)—an x-ray of the heart's circulation that is done after injection of contrast dye
Treatment
If your child has mild AS, his condition will be monitored. He may not need treatment right away.
Lifestyle Changes
If your child has moderate to severe AS, the doctor may advise him to avoid strenuous physical activity. For example, your child will not be able to play competitive sports.
Medicines
If necessary, your child may be given medicines to help prevent heart failure . In certain cases, your child may need to take antibiotics before dental appointments or surgical procedures. This is to prevent an infection that could affect his heart.
Surgery
Severe AS may require surgery. Options include:
- Balloon valvuloplasty —A balloon device is passed through the arteries to open or enlarge the aortic valve. This may provide relief of symptoms. Since the valve can become blocked again, this surgery may need to be repeated.
- Aortic valve replacement —This is the surgical replacement of a defective heart valve.
