Aortic Stenosis

Aortic Stenosis

What is aortic stenosis?

Aortic stenosis is a heart defect that may be congenital (present at birth) or acquired (develop later in life). If the problem is congenital, then something occurred during the first 8 weeks of pregnancy to affect the development of the aortic valve.

The aortic valve is found between the left ventricle and the aorta. It has three leaflets that function like a one-way door, allowing blood to flow forward into the aorta, but not backward into the left ventricle. Aortic stenosis is the inability of the aortic valve to open completely.

With aortic stenosis, problems with the aortic valve make it harder for the leaflets to open and permit blood to flow forward from the left ventricle to the aorta. In children, these problems can include a valve that:

Aortic stenosis may be present in varying degrees, classified according to how much obstruction to blood flow is present. A person with severe aortic stenosis will be quite ill, with major symptoms noted early in life. A person with mild aortic stenosis may have few symptoms, or perhaps none until later in adulthood. The degree of obstruction can become worse with time.

Congenital aortic stenosis occurs in 4 to 6 percent of all children with congenital heart disease. Relatively few children are symptomatic in infancy, but the incidence of problems increases sharply in adulthood.

Congenital aortic stenosis occurs three times more often in boys than in girls.

Aortic Stenosis

What causes aortic stenosis?

Congenital aortic stenosis occurs due to improper development of the aortic valve in the first 8 weeks of fetal growth. It can be caused by a number of factors, though, most of the time, this heart defect occurs sporadically (by chance), with no apparent reason for its development.

Some congenital heart defects may have a genetic link, either occurring due to a defect in a gene, a chromosome abnormality, or environmental exposure, causing heart problems to occur more often in certain families.

Acquired aortic stenosis may occur after a strep infection that progresses to rheumatic fever.

Why is aortic stenosis a concern?

Mild aortic stenosis may not cause any symptoms. Several problems may occur, however, when aortic stenosis is moderate to severe, including the following:

What are the symptoms of aortic stenosis?

The following are the most common symptoms of aortic stenosis. However, each person may experience symptoms differently. Symptoms may include:

The symptoms of aortic stenosis may resemble other medical conditions or heart problems. Always consult your physician for a diagnosis.

How is aortic stenosis diagnosed?

Your physician may have heard a heart murmur during a physical examination, and referred you to a cardiologist for a diagnosis. A heart murmur is simply a noise caused by the turbulence of blood flowing through the obstruction from the right ventricle to the pulmonary artery.

A cardiologist specializes in the diagnosis and medical management of congenital heart defects, as well as heart problems that may develop later in life. The cardiologist will perform a physical examination, listening to your heart and lungs, and make other observations that help in the diagnosis. The location within the chest that the murmur is heard best, as well as the loudness and quality of the murmur (harsh, blowing, etc.) will give the cardiologist an initial idea of which heart problem you may have. Diagnostic testing for congenital heart disease varies by age, clinical condition, and institutional preferences. Some tests that may be recommended include the following:

Treatment for aortic stenosis

Specific treatment for aortic stenosis will be determined by your physician based on:

Aortic stenosis is treated with repair of the obstructed valve. Several options are currently available.

Activity may be limited in patients who have moderate aortic stenosis prior to repair. For instance, competitive sports that require endurance may be restricted.

Repair options include the following:

Postoperative care

After surgery, special equipment will be used to help the patient recover from surgery, and may include the following:

The patient will be kept as comfortable as possible with several different medications; some of which relieve pain and some of which relieve anxiety.

After discharge you may need to take medications for a while, and these will be explained to you. The staff will give you instructions regarding medications, activity limitations, and follow-up appointments before you are discharged.

Long-term outlook after aortic stenosis surgical repair

Most patients who have had an aortic stenosis surgical repair will live healthy lives. Activity levels, appetite, and growth should eventually return to normal.

Over time, a valve that was ballooned may once again become narrowed. If this happens, a second balloon procedure or operation may be necessary to repair aortic stenosis. Sometimes the aortic tissue itself may be abnormal, which might lead to complications in the teen or adult years. Regular follow-up care at a specialized cardiac center should continue throughout life.

Your cardiologist may recommend that antibiotics be given to prevent bacterial endocarditis after discharge from the hospital.

Individuals who had a mechanical valve replacement may need to take anticoagulants (blood thinners) to prevent blood clots from forming on the artificial valve surfaces. Regular monitoring of the blood’s clotting status is very important in maintaining the most appropriate dose of anticoagulants.

Initial valve replacement is often performed using a tissue valve to avoid the need for anticoagulation, especially for females of childbearing age. Anticoagulation during pregnancy is very difficult to manage, and requires special treatment.

Repeat valve replacement is not uncommon during the lifespan. In addition, blood pressure should be closely monitored and managed.

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