Aortic Valve Stenosis  (AVS)

What is aortic valve stenosis?

Aortic stenosis (AS) is a narrowing or tightening of the aortic valve. This narrowing prevents blood from passing through the valve effortlessly, forcing the heart to work harder to push blood out to the body. There are several degrees of AS, ranging from mild to severe, and the location of the stenosis can vary.

• Subvalvular – The narrowing is below the aortic valve
• Valvular – The narrowing is at the aortic valve with fusion of valve leaflets
• Supravalvular – The narrowing is above the aortic valve

Aortic stenosis results in a muscle enlargement, or compensatory ventricular hypertrophy, of the left ventricle. The degree of hypertrophy is generally related to the severity of the stenosis.

What are the symptoms of aortic valve stenosis?

Many children with mild to moderate aortic valve stenosis don’t have any symptoms at first. The only symptom they may have is a heart murmur. This is an extra heart sound your child’s doctor can hear using a stethoscope.

Over time, the aortic valve stenosis may progress and cause symptoms including:

• Shortness of breath
• Chest pain
• Feeling tired
• Fainting 

What causes aortic valve stenosis?

• An aortic valve that is too narrow
• An aortic valve has two leaflets instead of three
• The leaflets are thicker and limit the normal movement of the valve

Aortic valve stenosis can also be caused by rheumatic fever, which can scar the valve. 

How is aortic valve stenosis treated?

Your child’s treatment will depend on their age and how severe their condition is. Some children with mild aortic valve stenosis may not need any treatment. Instead, your child’s doctor may track their condition over time. Your care team at Arkansas Children’s is experienced in treating aortic valve stenosis and will work with you to come up with the best treatment option for your child. Treatments may include:

• Balloon valvuloplasty is the most common treatment for aortic valve stenosis. It is a minimally invasive procedure using a narrow, flexible tube called a catheter. During the procedure, the doctor inserts the catheter into a blood vessel in the groin. Then, a wire guides the catheter across the aortic valve. Once in the proper position a balloon is inflated to stretch the valve open. Then the balloon is deflated and removed.
• Your child may need a valve repair or replacement if their condition is more severe. It may also be a next step if your child has had a balloon valvuloplasty and the valve has become narrow again. Repairing the valve to improve its function is the first choice, if at all possible. If repair is not an option, your child’s doctor may discuss replacing the valve with an artificial or donor valve.
• While the surgical techniques for each of these valvular narrowings are different, the objective is the same: to relieve the obstruction. Surgical treatment for aortic stenosis involves making an incision through the breastbone (sternotomy). A machine that allows the heart and lungs to rest (cardiopulmonary bypass) is used to allow the surgery team to repair the area of concern.
  • Subvalvular Stenosis (below the valve) – The aorta is opened just above the valve, and the obstruction is removed from below the valve (subvalvular ring of tissue).
  • Valvular Stenosis (at the valve) – The aorta is opened in a similar fashion, however the valve itself is addressed.
  • Supravalvular Stenosis (above the valve) – An incision is made over the affected area and a patch is sewn in place to enlarge the narrowing (aortoplasty).

After an aortic stenosis repair, monitoring in the postoperative period will include invasive lines, such as an arterial line and central venous line, to monitor blood pressure and deliver medications. Medications may be needed to control blood pressure, provide sedation and maintain hydration during recovery. Depending on various factors specific to each individual, the breathing tube (endotracheal tube) may or may not still be present after surgery. Surgical drains will be present to remove air, blood or fluid from around the heart or lungs. These tubes will be removed in the ICU as soon as possible, typically the next day.

Length of stay can vary but typically ranges from 7-10 days, depending on the degree of stenosis and associated surgical repair required.