Aortic Stenosis
Normal aorta – the tube lighting up red from the upper part of the heart.
Aortic Stenosis
What is Aortic Stenosis?
The aorta is the largest artery (blood vessel) in the body. It carries red oxygenated blood from the heart around the body. The connection between the heart and the aorta is guarded by a valve called the aortic valve. Normally it has 3 leaflets and has the appearance of a Mercedes Benz sign.
Narrowing of the aortic valve is known as aortic stenosis.
Aortic stenosis increases the work of the heart causing the left ventricle (lower pumping chamber) to thicken (known as left ventricular hypertrophy) and potentially eventually fail. Aortic stenosis can be mild, moderate, severe or critical (the latter is an emergency). The narrowing can be at the level of the valve, or above the valve (supravalvar) or below the valve (subvalvar). The valve can be malformed and instead of having 3 leaflets it may only have 2 (bicuspid) or more rarely 1 (monocuspid).
Symptoms
There is a wide spectrum of symptoms and some babies and children will have no symptoms at all and the only indication of a problem may be the detection of a heart murmur. Babies may present with breathing and feeding difficulties, and in the most severe cases, with pallor and shock. Older children may become breathless, tire more easily, and fainting can occur.
Diagnosis
A clinical examination will usually reveal a heart murmur. Sometimes a buzzing sensation (a thrill) is felt in the neck or on the chest. An echocardiogram will diagnose aortic stenosis. An ECG will also be performed and often a chest X-ray.
Aortic stenosis may also be diagnosed before birth by fetal echocardiography.
Treatment
Mild and moderate aortic stenosis is well tolerated and does not require treatment but should be regularly monitored in the outpatient clinic. There is a small possibility of spontaneous improvement with growth. Other cases become more severe with time whilst others remain stable for many years.
Aortic stenosis can be treated either via a keyhole approach with a balloon cardiac catheter (angioplasty) or by open heart cardiac surgery. Each child’s heart is individually assessed to decide which treatment will give the best long-term result.
Keyhole & Surgical Procedures
Balloon Cardiac Catheter
Involves a general anaesthetic. A tube, with a deflated balloon, is passed from a blood vessel in the leg to the heart, using X-ray guidance. The balloon is inflated to stretch the narrow opening. Hospital stay is usually 1-2 nights.
Open-Heart Surgery
Involves the cardiac bypass machine. Techniques include surgical repair of the valve, replacement with a mechanical or tissue valve, or the Ross operation (replacing the aortic valve with the child's own pulmonary valve).
Cardiac Surgery
Keyhole Procedure
Prognosis
The outlook for children with aortic stenosis is excellent in the vast majority of cases. Regular medical follow-up will be required throughout life. Dr Naqvi says: “Having aortic stenosis does not stop children from having a happy full life.”
Those with moderate to severe aortic stenosis will be advised to avoid certain potentially harmful sports, but there are usually still many sports they can enjoy. Many patients after treatment have excelled in school sports, music, and academics.