Aortic Stenosis in Children

How Does Aortic Stenosis Affect the Heart and Body?

When the aortic valve narrows, the heart has to work much harder to push blood through the small opening. This can cause the following effects:

• Heart Muscle Thickening: The heart’s left ventricle (main pumping chamber) becomes thicker and stiffer over time, making it harder for the heart to pump blood.
• Reduced Blood Flow: Since blood has a harder time leaving the heart, the body may not get enough oxygen. This can cause tiredness, dizziness, and shortness of breath.
• Chest Pain: The heart muscle may not get enough oxygen, causing chest pain (angina).
• Fainting (Syncope): Reduced blood flow can cause children to feel lightheaded or faint, especially during physical activity.
• Heart Murmur: When listening to your child's heart, a doctor may hear an unusual "whooshing" sound.
• Heart Failure: If the heart becomes too weak, it can cause fluid buildup in the lungs or legs, causing swelling and breathing difficulties.

What Causes Aortic Stenosis?

Aortic stenosis can happen for several reasons, including:

• Congenital Heart Defect: Some children are born with a valve that has only two flaps (bicuspid valve). This valve is more likely to become narrow as they grow.
• Calcium Buildup: Over time, minerals like calcium can build up on the valve, making it stiff and less able to open properly (this usually happens in adults but can occur in children with congenital valve problems).
• Rheumatic Fever: If a child has had rheumatic fever (from untreated strep throat), it can scar the valve, making it stiff.
• Genetic Conditions: Some genetic syndromes, like Turner syndrome, can increase the risk of aortic stenosis.

What Are the Symptoms of Aortic Stenosis?

Children with mild aortic stenosis may have no symptoms, but as the valve narrows, symptoms can appear. Watch for:

• Shortness of Breath: Especially during play or physical activity.
• Fatigue: Children may tire more quickly than other kids.
• Chest Pain: Your child may complain of a tight or squeezing feeling in the chest.
• Fainting (Syncope): Your child may suddenly feel dizzy or faint, especially during exercise.
• Heart Murmur: A doctor may hear a "whooshing" sound during a checkup, which can be a sign of aortic stenosis.
• Swelling (Edema): In severe cases, fluid can build up in the legs, ankles, or belly.
• If you notice any of these symptoms, see a doctor. Early diagnosis and treatment can prevent complications.

How is Aortic Stenosis Diagnosed?

To diagnose aortic stenosis, your child’s doctor may use the following methods:

• Physical Exam: The doctor will listen for a heart murmur, check for swelling, and ask about symptoms like chest pain or fainting.
• Echocardiogram (Heart Ultrasound): This is the most important test. It uses sound waves to create a video of the heart, allowing the doctor to see how well the valve works.
• Electrocardiogram (ECG): This test measures the heart's electrical activity and can detect heart strain caused by aortic stenosis.
• Chest X-ray: This shows the size and shape of the heart and looks for signs of fluid buildup in the lungs.
• Cardiac Catheterization: Sometimes, a thin tube (catheter) is inserted into the heart to measure the pressure inside the heart and see how well the valve works.

What Are the Different Types of Aortic Stenosis?

Aortic stenosis can be classified by where the narrowing happens:

• Valvular Aortic Stenosis: This is the most common type, and it occurs when the aortic valve itself becomes narrow or stiff.
• Subvalvular Aortic Stenosis: The narrowing occurs just below the valve due to extra muscle or tissue in the heart.
• Supravalvular Aortic Stenosis: The narrowing happens in the aorta (the large blood vessel) just after it leaves the heart. This is sometimes linked to genetic conditions like Williams syndrome.

How is Aortic Stenosis Treated?

Treatment depends on the severity of the narrowing and symptoms. Options include:

Monitoring:

Watch and Wait: If aortic stenosis is mild, your child’s doctor may recommend regular checkups to monitor the valve over time.

Medications:

While medicines do not "fix" the valve, they can help manage symptoms like swelling or heart strain.

• Diuretics (water pills) reduce fluid buildup.
• Blood Pressure Medications lower the heart's workload.

Balloon Valvuloplasty:

This is a less invasive procedure where a small balloon is inserted into the heart and inflated to widen the aortic valve. It’s often used for children and teens.

It may not be a permanent fix, and the valve might narrow again, but it can delay the need for surgery.

Aortic Valve Replacement:

If the valve is too damaged, it may need to be replaced.

This can be done through open-heart surgery or a minimally invasive procedure called TAVR (Transcatheter Aortic Valve Replacement), depending on your child's age and health.

How Can Parents Help Prevent Aortic Stenosis?

While some causes of aortic stenosis (like congenital heart defects) cannot be prevented, there are ways parents can support their child's heart health:

• Get Regular Checkups: Early detection is key to managing the condition.
• Control Risk Factors: If your child has high blood pressure or high cholesterol, work with your child’s doctor to manage these.
• Prevent Infections: Ensure your child receives treatment for strep throat to prevent rheumatic fever, which can damage heart valves.
• Follow the Treatment Plan: If your child is diagnosed with aortic stenosis, follow your doctor’s advice about monitoring, medication, and lifestyle changes.

What Happens if Aortic Stenosis is Not Treated?

If severe aortic stenosis is left untreated, it can lead to serious health problems:

• Heart Failure: The heart becomes too weak to pump blood effectively.
• Arrhythmias: Irregular heartbeats can develop, which may cause dizziness or fainting.
• Pulmonary Hypertension: Pressure can build up in the lungs' blood vessels.
• Sudden Cardiac Arrest: In severe cases, untreated aortic stenosis can cause sudden heart failure.



The good news is that with early diagnosis and proper treatment, most children with aortic stenosis can lead healthy, active lives. If you’re concerned about your child’s heart health, talk to Dr. David Youssef, a specialist in Paediatric Cardiology.