Aortic Stenosis

Aortic stenosis is a narrowing of the aortic valve. This means that the flow of blood from the left ventricle into the aorta is less efficient than in a normal heart. The result is that the body does not get as much oxygen as it should.

The aortic valve itself may be too narrow, or there may be narrowing above the valve – supravalvular stenosis or below the valve – subvalvular stenosis. The narrowing may be mild, moderate or severe.

Balloon catheter: One way of increasing the flow of blood through the valve is to use a balloon catheter. This is a fine plastic tube with a balloon on the end. It is pushed through a vein or artery (usually at the top of the leg) into the heart and inserted through the valve. The balloon is then inflated across the valve, stretching it in the process. The balloon is then deflated and withdrawn.

Balloon catheterisation does not leave any scars and your child may be able to leave hospital that day. Sometimes the process causes the valve to leak but this is not usually a problem, provided the leak is small. If the valve narrows again in the future, the procedure may have to be repeated. If the procedure does not work, your child will be offered surgery.

Surgery: This is open heart surgery, which means that the heart will need to be stopped and opened to repair it. A heart bypass machine will take over the job that the heart normally does. The aim of the operation is to stretch or replace the aortic valve, or to reduce the obstruction above or below it.

If your child has other heart defects, the surgery performed will depend on how the heart can best be modified to cope with all the problems there are.

For older children this surgery is normally low risk, but it will depend on how well your child is otherwise. The cardiologist or surgeon should discuss the risks with you in detail before asking you to consent to the operation.

The aortic valve can be replaced by an artificial valve which is specially designed to be strong enough to withstand the high pressure of blood pumped from the left ventricle. However, artificial valves do not grow with the child, so further valve surgery may be needed. Children with artificial valves will also need to take anticoagulants for the rest of their lives, which can have a number of implications for their health and lifestyle.

An alternative to using an artificial valve is to do a Ross procedure. In this operation the child’s own pulmonary valve will replace the aortic valve (an autograft). A human tissue valve (a homograft) then replaces the pulmonary valve.

Children having these sorts of operations will usually spend 7-10 days in hospital, of which one or two will be spent in the intensive care and high dependency unit. Of course, this depends on how well your child is before and after the surgery, and whether any complications arise.

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