Definition

Aortic stenosis (AS) is a narrowing of the aortic valve opening. This valve controls the flow of blood from the heart to a large artery called the aorta. This artery carries blood from the heart to the rest of body.

AS makes it hard for blood to flow out of the heart. It can lower the amount of blood that goes to the body and cause a back-up of blood into the heart. This back-up can raise pressure in the heart and lungs. AS can range from mild to severe.

Heart Chambers and Valves

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Causes

The aortic valve is made up of 3 cusps that open and close together. In babies, AS is caused by a birth defect that may result in:

• 1 cusp that cannot open as fully as 3 cusps
• 2 cusps that are damaged
• Cusps that are partly closed or do not open the right way due to thickness

The valve can also be damaged by infection.

Risk Factors

Things that may raise a child's risk of AS are:

• Having other family members who have congenital valvular heart diseases
• Rheumatic fever—which can happen after a strep infection
• Bacterial endocarditis—infection of the heart

Symptoms

Mild AS may not cause any problems. More severe AS may cause:

• Extreme lack of energy after activity
• Lightheadedness with activity
• Fainting with activity
• Rapid or irregular heartbeat
• Shortness of breath
• Pain, squeezing, pressure, or tightness of the chest, usually with activity

Rarely, AS may cause heart rhythm problems and sudden death.

Diagnosis

The doctor will ask about your child’s symptoms and health history. A physical exam will be done. It will focus on the chest and heart.

Pictures may be taken to view the heart and structures around it. This can be done with:

• Chest x-ray
• Echocardiogram
• Rarely, cardiac catheterization

Treatment

Mild AS will be monitored for any changes or problems. Treatment may not be needed right away.

Choices for moderate to severe AS are:

• Lifestyle changes, such as avoiding strenuous activities
• Medication to lower stress on the heart and prevent heart failure

Some children may need surgery. Choices are:

• Balloon valvuloplasty to open the aortic valve or make it bigger
• Aortic valve replacement to replace a defective heart valve

Prevention

There are no known guidelines to prevent this health problem.