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Aortic Valve Disease

What is Aortic Valve Disease?

The aortic valve is one of four valves (tissue flaps) in the heart that are vital to its normal function. With each heartbeat, the tissue flaps open and shut, working in concert with contraction and relaxation of the heart chambers to propel blood through the heart’s four chambers and to the rest of the circulation.
Heart valves keep blood flowing in a forward direction. The normal heart has four valves:

Left Side

  • Mitral valve - allowing flow from left atrium to left ventricle
  • Aortic valve – allowing flow from left ventricle to body circulation

Right Side

  • Tricuspid valve – allowing flow from right atrium into right ventricle
  • Pulmonary valve – allowing flow from right ventricle to lung circulation

A hardened or fused valve, also known as aortic stenosis, leads to obstruction, forcing the left ventricle (the heart’s lower left chamber) to work harder to pump blood into the aorta.


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A leaky aortic valve, also called aortic insufficiency (otherwise, called aortic regurgitation), is a valve that does not shut properly. Therefore, blood leaks back into the left ventricle. The ventricle enlarges in response to accommodate the leaking volume of blood in excess of the usual volume of blood, forcing it to use more effort to expel blood into the body.

Some valve defects have both problems. A stiff valve partially obstructs blood flow from the heart, but since it also does not close properly, blood leaks.

These defects overtax the left ventricle and, with time, the ventricle can fail to perform properly.

What are the causes?

Many valve defects occur before birth. Aortic valve disease can be congenital (a child is born with the valve problem) or it may be acquired later in life. A normal aortic valve has three “cusps” or leaflets. Some children are born with a bicuspid valve having only two leaflets. Often times, a bicuspid valve does not require any intervention until much later in adulthood.

Untreated strep throat can develop into rheumatic fever, which in turn, can scar the valve. That is why taking a full course of prescribed antibiotics is vital.

How is it diagnosed?

In infants, lethargy, poor feeding (or poor food intake) and difficulty breathing may signal a valve problem. Rarely, fainting or chest pain also may indicate a problem for older children.

Though valve disease may have no warning signs, doctors may hear an odd, whooshing sound (or heart murmur) via stethoscope. The following tests may be utilized to find more details:

  • An electrocardiogram (EKG or ECG) can check the heart’s electrical action to reveal damage or irregular rhythms.
  • Chest X-rays create images of the heart and lungs and can show fluid in the lungs due to valve defects.
  • An echocardiogram (echo) uses sound waves (ultrasound) to produce images of the heart and vessels on a screen that reveals whether the heart is pumping properly.
  • A cardiac MRI (magnetic resonance imaging) uses radio waves, magnets and a computer to form three-dimensional images of the heart, which can reveal structural abnormalities.
  • Cardiac catheterization involves a thin, long tube that is inserted into a blood vessel – usually from the groin – and guided into the heart to obtain direct pressure measurements and angiograms (X-ray images of the heart chambers and valves). It may provide therapy for aortic valve stenosis using balloon-tipped catheters (balloon aortic valvuloplasty).

How is it treated?

Aortic valve repair is possible occasionally, 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 many 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.

Valve TypeAdvantageDisadvantage
Mechanical
  • Lasts a long time
  • Straightforward to implant
  • Needs anticoagulation
  • Does not grow
Tissue Valve
  • Straightforward to implant
  • Does not need anticoagulation
  • Limited longevity
  • Does not grow
Homograft (human cadaver valve)
  • Does not need anticoagulation
  • Limited longevity
  • Does not grow
  • Complex to implant
Ross Procedure (autograft)
  • Does not need anticoagulation
  • May last for decades
  • Complex to implant
  • Still may require future operations

Aortic valve disease affects each child differently. Your physician is always your best resource for providing you with the best treatment options specific to your child’s condition.

Why choose the Children’s Heart Center?

As part of the Children’s Heart Center at Children’s Memorial Hermann Hospital, the affiliated cardiologists and affiliated cardiovascular surgeons collaborate as a multidisciplinary team to treat babies prior to birth, infants, children and young adults with congenital and acquired heart disorders. The team of affiliated physicians, nurses and coordinators work together with you to determine the best treatment plan for your child. Your child’s referring physician is also kept fully informed of your child’s treatment plan.

At Children’s Memorial Hermann Hospital, the affiliated cardiologists and affiliated cardiovascular surgeons understand the unique challenges, circumstances and intricacies of caring for young patients with heart conditions. In addition to the team’s medical expertise, Children’s Memorial Hermann Hospital provides families with patient-centered care, keeping families fully involved as part of the child’s treatment team as well as offering resources to meet the needs of your entire family.

Contacts

Pediatric Cardiology Clinic
The University of Texas Health Science Center Professional Building
6410 Fannin, Suite 370
Houston, TX 77030
Phone: (832) 325-6516

Pediatric Cardiovascular Surgery Clinic
The University of Texas Health Science Center Professional Building
6410 Fannin, Suite 950
Houston, TX 77030

Clinic Phone: (832) 325-7234
Nurse Line: (713) 500-7324

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Note: This page is meant to be a helpful, informative introduction on the subject of aortic valve disease in children. The information may not be applicable to all cases, especially if there are additional defects. It is not meant to replace the opinion of a personal physician.

03/2016 – This page was updated and approved by an affiliated pediatric physician at the Children’s Heart Center.