Pediatric Heart Care Aortic Stenosis
Information from Kids Health
The aortic valve directs blood from the left ventricle into the aorta (the large vessel that carries blood to the rest of the body). If the aortic valve is narrowed, or stenotic, less blood flows from the left ventricle to the aorta and out to the body.
Concerns and Symptoms
Aortic stenosis can occur in the valve itself or in the muscles just underneath the valve. The more severe the narrowing, the more symptoms the child will have, and the earlier the disorder will be detected.
Over time, the left ventricle has to work harder to pump blood through the narrow aortic valve. The heart muscle may enlarge and become less able to pump blood effectively, and the child may develop congestive heart failure.
Infants with severe aortic stenosis will be critically ill shortly after birth. Children with less severe aortic stenosis may show symptoms of fatigue, dizziness, shortness of breath, irregular heartbeat or chest pain. Older children and adolescents may have a heart murmur or some degree of heart failure.
In some cases, aortic valve stenosis can be treated by inserting a balloon through the narrow area and inflating it, thereby opening up the stenosis. This type of procedure is performed by interventional cardiologists.
In other cases, surgical repair of the valve is necessary. The operation is performed under general anesthesia, which means the child will be asleep during surgery.
First the surgeon makes a vertical incision in the front of the chest, opens the breastbone and exposes the heart. Blood from the heart is redirected to a bypass machine. The bypass machine does the job of the heart and lungs during the operation.
The specific type of operation performed depends on the type and severity of aortic stenosis and the age of the child. Operations include:
- Valvotomy - The aortic valve is reconstructed to allow blood to pass through more easily. If the stenosis is caused by tissue or muscles underneath the aorta, these may be removed as well.
- Ross procedure - The aortic valve is replaced with the child's own pulmonary valve. A pulmonary valve from a tissue donor is then placed where the existing pulmonary valve had been.
- Subaortic stenosis membrane resection - The membrane causing the obstruction is removed, thereby opening up the outflow tract.
- Valve replacement - The aortic valve is replaced with either a mechanical valve, a valve from an animal donor or a valve from a human donor.
After the valve is repaired or replaced, and the heart closed, the surgeon shuts down the heart-lung bypass machine, and the heart starts beating again. The surgeon then closes the breastbone and chest incision, and applies bandages to the incision site.