Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Aortic Stenosis—Child

(Stenosis, Aortic—Child; AS—Child)
by Michelle Badash, MS and Rebecca J. Stahl, MA
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:

  • Cusps that are partly closed or do not open correctly due to thickness
  • One cusp instead of three—When the heart valve is closed, the cusp seals the area.
  • Two cusps that are damaged

Damage to the aortic valve can also be caused by certain conditions, like these infections:

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:

  • Dizziness with exertion
  • 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

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:

  • Cardiac catheterization (rarely done)—an x-ray of the heart's circulation that is done after injection of contrast dye
  • Chest x-ray —a test that uses radiation to take pictures of structures inside the chest
  • Echocardiogram —a test that uses sound waves (ultrasound) to examine the size, shape, and motion of the heart
  • 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
  • Exercise stress test —the recording of the heart during exercise
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:

  • Aortic valve replacement —This is the surgical replacement of a defective heart valve.
  • 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.
Prevention

Congenital AS cannot be prevented.

Last reviewed: June 2011 by Kari Kassir, MD.

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