Aortic Valve Stenosis (AVS) In Children: Symptoms, Diagnosis And Treatment Options

Heart defects present at birth, known as congenital heart defects, come in all forms and cause several different types of diseases. One such disease is aortic valve stenosis.

What is aortic valve stenosis?

Valves located in many parts of the heart are meant to to ensure that blood flows in the right direction. Aortic valve stenosis develops because one of the valves doesn’t work properly. This valve is located between the heart and the rest of the body and so it enables oxygenated blood from the heart to flow to the rest of the body. If this valve does not work properly, the blood becomes trapped in the heart, causing pressure to build up in the heart, leading to significant damage, such as:

• Stenosis — narrowing or obstruction of the aortic valve. This causes the left side of the heart to pump harder to make sure the blood keeps flowing.
• Insufficiency, another word for which is regurgitation, strikes when blood is pumped through the valve backwards between heartbeats.

Among children with aortic valve stenosis, some will only experience stenosis while others mostly experience insufficiency. Some children, however, will experience both problems.

What is the cause of aortic valve stenosis?

Unfortunately, the cause behind why most children have this disease is not known. However, it is a very common type of heart defect. Some children may also have other heart defects in addition to aortic valve stenosis.

Symptoms of aortic valve stenosis in children

The symptoms associated with aortic valve stenosis tend to differ depending on the age of the child and the severity of the blockage. As an example, a child with a mild obstruction will only have a few symptoms (if any), while children with severe obstruction will have many problems. Babies with severe aortic valve stenosis are usually very sick.

Symptoms of severe aortic valve stenosis include:

• Feeling very tired or fatigued
• Having a bluish discoloration around regions such as the lips or skin due to low oxygen levels
• Babies have trouble feeding and not gaining enough weight
• Children will feel dizzy or lightheaded, particularly if they are participating in physical activity
• Fainting
• Being short of breath or breathing rapidly
• Irregular heart beat or heart palpitations
• Feeling pain or pressure in the chest

If your child is feeling any of these symptoms regularly, you should see a doctor right away.

How is aortic valve stenosis diagnosed?

Aortic valve stenosis may be diagnosed when your child’s doctor detects a heart murmur —an abnormal sound made when blood moves through the heart — when listening to the heart during a routine checkup. A heart murmur can mean many things, but can also sometimes point to a heart defect. This, along with the child's symptoms, will help your doctor reach an accurate diagnosis.

If your family doctor suspects your child may have aortic valve stenosis, they will refer you to a pediatric cardiologist who can confirm the diagnosis. The pediatric cardiologist may administer several different tests, including:

• A chest X-ray provides a picture of the organs inside your child’s chest, such as the heart and lungs.
• An electrocardiogram (ECG) measures the heart's electrical activity.
• An echocardiogram uses sound waves to create a moving, live, picture of the heart. This is one of the best tests to check for aortic valve stenosis.
• Cardiac catheterization is a test in which the doctor inserts a catheter (a thin and flexible tube) into your child’s blood vessels. This tube is guided to the heart and and this allows the doctor to get a more detailed picture of the heart's structures.
• An exercise test, in which the doctor performs an ECG while your child is exercising.
• Pulse oximetry is a test in which blood oxygen levels are measured using a clip on a finger.

How is aortic valve stenosis treated?

Aortic valve stenosis is treated in different ways depending on the child's symptoms, age, and overall health status (such as how severe the condition is). If your child doesn’t present with any symptoms or with only mild symptoms, doctors may just wait and watch the child as they may not require treatment. Treatment of aortic valve stenosis may include:

• Balloon aortic valvulopasty is a procedure that uses a catheter attached to a deflated balloon. This catheter is inserted into a blood vessel and guided up to the defective valve. There, the balloon is inflated which helps open up the valve and enables blood flow.
• Surgical aortic valvotomy is a surgery that helps eradicate scar tissue from the valve, allowing the valve to open properly.
• Aortic valve replacement is a surgery that involves replacing the defective valve with a new one. These valves can be artificial or they can come from donors or animals.
• Pulmonary autograft, also known as the Ross procedure. This surgery is conducted to replace the aortic valve, as well as a region of your aorta.