Aortic stenosis in children

Aortic stenosis in children . The aorta is the main artery that carries blood outside the heart . When blood leaves the heart, it flows through the aortic valve into the aorta. In aortic stenosis, the aortic valve does not open fully or decreases blood flow from the heart.

Summary

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  • 1 Aortic Stenosis (EA)
  • 2 Types of EA
  • 3 Causes of AD
  • 4 Symptoms
  • 5 Tests and reviews
  • 6 Possible complications
  • 7 How it affects the heart
    • 1 Disorders that justify the symptoms
  • 8 How EO is diagnosed
    • 1 Clinical symptoms
    • 2 Physical examination
    • 3 Chest radiographs
    • 4 Electrocardiogram (ECG)
    • 5 Echocardiogram
    • 6 Stress electrocardiogram
    • 7 Cardiac catheterization
  • 9 Treatment in EO
  • 10 This disease is curable
  • 11 Prognosis of disease
  • 12 Source

Aortic stenosis (EA)

Congenital aortic stenosis (present at birth) is a narrowing of the valve or duct that leaves the left ventricle , which is the heart’s most important blood pumping chamber. It is present in 3-6% of children with congenital heart disease and is four times more frequent in boys than in girls.

The number of symptomatic babies is relatively low, but the incidence of problems increases sharply as they reach adulthood. The aortic valve is located between the left ventricle and the aorta. It has three leaflets that function as a one-way gate, that is, they allow blood to flow into the aorta but not back to the left ventricle.

EA types

In this congenital heart disease, alterations in the aortic valve make it difficult to open the leaflets and advance blood from the left ventricle to the aorta. In children, these problems can include a valve that:

  • Only have one or two leaflets instead of three.
  • Have three leaflets that are partially fused.
  • Have three thicker leaflets that do not fully open.

Aortic stenosis is classified according to the degree of obstruction to the flow of blood.

Causes of AD

However, most of the time this heart defect occurs sporadically (by chance), for no apparent reason. Generally it is not a condition inherited from the parents.

Although the specific cause is unknown, the presence of congenital stenosis means that an incident occurred during the first 8 weeks of fetal growth that caused inadequate development of the aortic valve. As the aortic valve becomes more narrow, the pressure increases within of the left ventricle of the heart.

This makes the ventricle thicker, which decreases blood flow and can lead to chest pain. As the pressure continues to increase, the blood may be dammed up in the lungs and breathing may be difficult.

Severe forms of aortic stenosis prevent enough blood from reaching the brain and the rest of the body, resulting in dizziness and fainting. Aortic stenosis can be present from birth (congenital) or can develop later in life (acquired). Children with aortic stenosis may have other congenital conditions. Aortic stenosis is not very common and occurs more frequently in men than in women.

Symptoms

People with aortic stenosis may have no symptoms at all until later in the course of the disease. The diagnosis may have been made when the doctor heard a heart murmur and then performed additional tests. Among the most frequent symptoms, although each child may suffer in different ways, are:

  • Fatigue or easy tiredness.
  • Dizziness or weakness when exerting an effort.
  • Difficulty breathing that is accentuated by exercise.
  • Irregular heartbeat or palpitations.
  • Pain in the chest with a feeling of tightness that increases during exertion and decreases when resting.
  • Cough
  • Decreased urine output (urine output)
  • Panting with activity
  • Chest pain , angina type:
  • tension, pressure , tightness, compression
  • pain increases with exercise and relieves with rest
  • under the sternum and can radiate to other areas *
  • Fainting, weakness, or vertigo with activity
  • Feeling of perceiving heartbeat (palpitations)

In infants and children, symptoms include:

  • Fatigue or fatigue more easily than others with exertion (in mild cases)
  • Serious breathing problems that occur within days or weeks after birth (in severe cases)

Children with mild or moderate aortic stenosis may worsen as they grow older and are also at risk of developing a heart infection ( bacterial endocarditis ).

Tests and exams

The Doctor may feel a vibration or movement when placing the hand on the person’s heart. Most often, a puff, click, or other abnormal noise is heard through the stethoscope. There may be a weak pulse or changes in the quality of the Neck Pulse , which is known as a slow, weak pulse.

Babies and children with aortic stenosis can be extremely tired, sweaty, with pale skin and fast breathing. Also, they may be smaller than children their age. The blood pressure may be low. The following tests may be carried out:

  • Chest x-ray
  • Doppler ultrasound
  • ECG
  • Stress test
  • Left cardiac catheterization
  • MRI of the heart
  • Transesophageal echocardiography (TEE)

Possible complications

  • Arrhythmias
  • Endocarditis
  • Left heart failure
  • Left ventricular hypertrophy (enlargement) due to the extra effort of pushing blood through the narrow valve

How it affects the heart

The aorta is a large artery that originates from the left ventricle. Aortic stenosis is a narrowing or obstruction of the aortic valve of the heart that does not allow it to open properly, and prevents blood flow from the left ventricle to the aorta.

When the valve abnormality is severe, the heart will have to work harder to push blood into the body, and thickening of the left ventricular muscle (hypertrophy) will occur . The Hypertrophy may cause disorder in the circulation of the coronary arteries .

Disorders that justify the symptoms

  • The left ventricle must work harder to move blood through a narrow aortic valve. Over time, the left ventricle can no longer support this additional effort, and stops effectively pumping blood to the body.
  • You are more likely to develop an infection in the lining of the heart or in the aorta (known as bacterial endocarditis).
  • The coronary arteries, which supply oxygen-rich (red) blood to the heart muscle, may not receive enough blood to meet the demands of the heart.

How is EO diagnosed

Clinical symptoms

The symptoms that the child presents can help the diagnosis.

Physical exploration

A type of murmur can be heard on auscultation of the heart (it is simply a noise caused by turbulence of blood flowing through the obstruction from the right ventricle to the pulmonary artery). A palpable tremor or agitation may also be seen in the chest, such as a vibration felt when you put your hand over your heart. The pulse may be weak and the blood pressure may be low.

Chest x-rays

Dilation is observed at the outlet of the aortic artery and Calcification of the aortic valve may appear over time .

Electrocardiogram (ECG)

It measures the electrical activity of the child’s heart and there are signs of left ventricular growth or arrhythmias (unusual patterns of heartbeat).

Echocardiogram

It is the best diagnostic method and shows us the thickening of the aortic valve and ventricular growth (hypertrophy). In addition, it enables the structure and function of the heart to be evaluated using sound waves that are recorded to produce a moving image of both the heart and heart valves.

Stress electrocardiogram

A stress test is done to see the child’s heart’s response to exertion and exercise. Monitoring is carried out while the child runs on a moving treadmill or on an exercise bike.

Cardiac catheterization

It is an invasive procedure that provides very detailed information about the internal structures of the heart. Once the patient is sedated, a small, thin, flexible tube (catheter) is inserted into a blood vessel in the groin and guided into the heart. It allows the measurement of blood pressure and oxygen in the four chambers of the heart, the pulmonary artery and the aorta. In addition, a contrast medium can be injected to more clearly visualize the structures within the heart.

Treatment in EO

Medical treatment consists of the administration of diuretics, digoxin and other drugs that allow controlling episodes of heart failure. When aortic stenosis is severe, it is treated by repairing the altered valve (surgery).

If it is not severe, it will not require surgical intervention. Children with moderate aortic stenosis are likely to have to limit their activities before surgical repair, especially competitive sports that require endurance. If the tightness is severe, the child should not do heavy exercise or heavy work.

If it is not severe, you will be able to play and work according to your tolerance, although valve replacement may be necessary later in some patients.

This disease is curable

Aortic stenosis is a Heart Disease curable by surgical repair, although there is a continuous risk of arrhythmias that can sometimes cause sudden death. The person may not feel symptoms until complications develop. Without surgery, good results cannot be expected in cases of signs of angina or heart failure. Surgical valve repair or replacement is the best treatment for symptomatic aortic stenosis. Various repair options are currently available including:

Balloon valve dilation: This is performed by cardiac catheterization, in which the catheter has a deflated balloon at the end. When placed on the stenciled valve, the balloon is inflated to dilate the narrowed valve area.

  • Valvulotomy: Consists of releasing adhesions by surgery that prevent the valve leaflets from opening properly. Aortic valve replacement: in this case the aortic valve is replaced by a new mechanism: either tissue valves, which include animal valves (also called biological valves ) or mechanical valves , which can be metal, plastic or other artificial mechanism.

Disease prognosis

For a long period of time, children may be asymptomatic, but when shortness of breath (dyspnea) appears, survival is low (2 years). Two thirds of children die from congestive heart failure.

They may not require immediate valve repair as infants, but they should receive antibiotics before procedures such as dental check-ups or dental cleanings, to avoid severe infection of the internal surfaces of the heart (known as bacterial endocarditis). Most children with surgical repair of aortic stenosis leads healthy lives. Over time, activity, appetite, and growth levels should return to normal.

As the child grows, a ballooned valve may narrow again, and if this happens, a second balloon procedure or operation may be needed to repair the aortic stenosis. Children who have had an artificial valve replacement may need to take anticoagulants (blood thinners), to prevent clots from forming on the surfaces of the artificial valve.

 

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