Children's Heart Institute
Aortic Valve Disease
The aortic valve is a vital part of the working of the heart and is often involved in heart defects in children. When discussing aortic valve problems, it is best to first understand heart valves in general, to understand how a defect in the aortic valve can affect the heart.
Heart valves keep blood flowing in one direction. The normal heart has four valves:
The hearts valves going into the ventricles keep blood that the ventricle pumps from going back to the atrium. The heart valves at the outlet of the ventricles keep the blood from going back into the ventricle in between beats. The valves work together to keep the blood going in the correct direction.
Aortic stenosis is when the aortic valve does not let the blood, going the correct direction, pass through easily (an obstructed aortic valve). In this case, the left ventricle has to work harder to pump the blood past the obstructed valve into the aorta.
Aortic insufficiency is when the valve doesn't close properly (a "leaky" aortic valve), causing the left ventricle to repump the blood that had been pumped into the aorta but traveled backward into the ventricle.
Some valve defects have a component of both, where an immobile valve partially obstructs the flow out of the heart, but also doesn't close properly, so it also leaks.
In either kind of defect, there is extra work for the left ventricle. For aortic stenosis, it is extra "pressure" work (generating more pressure within the cavity of the ventricle to push the blood past the obstruction). For aortic insufficiency, it is extra "volume" work (repumping the blood that has come back from the aorta). If overstressed, the ventricle can slowly fail over time, thus, it is important to correct the aortic valve defect if the ventricle is sufficiently affected.
Aortic valves can occasionally be repaired, although this is uncommon. Young children with aortic stenosis can have their valves opened, either by a balloon procedure or by open surgery; however, this may not always be performed successfully. Older children and young adults can rarely have aortic stenosis repaired surgically. Even less commonly, aortic insufficiency can be repaired surgically. Thus, most people who have significant aortic valve problems require aortic valve replacement.
There are two types of replacement valves - each comes with its own set of advantages and disadvantages. In the table below, the term anticoagulation refers to the need to take "anticlotting" medications It is imperative that patients maintain careful follow-up so the amount of medication they receive is correct, and sometimes their lifestyle needs to be modified.
Straightforward to implant
Does not grow
Does not need anticoagulation
Homograft (human cadaver valve)
Complex to implant
Ross Procedure (autograft)
May last for decades
Still may require future operations
Some patients may choose a mechanical valve because it gives him/her the least chance of ever needing another heart surgery, but it does require anticoagulation. Other patients may prefer a tissue valve to avoid anticoagulation, knowing it will mean further heart surgery. Your surgeon will discuss with you and your family all of your options and help make the correct choice.
Pediatric Cardiology ClinicUniversity of Texas Health Science Center Professional Building
6410 Fannin, Suite 500
Houston, TX 77030
Phone: (832) 325-6516
Pediatric Cardiovascular Surgery ClinicUniversity of Texas Health Science Center Professional Building6410 Fannin, Suite 950Houston, TX 77030
Phone: (713) 500-7339
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