Treatment for Your Child’s Aortic Stenosis (AS)

Your child has aortic stenosis (AS). This condition occurs when the aortic valve doesn’t open all the way. It can also occur when the area above or below the valve is too narrow. As a result, blood flow from the heart to the rest of the body (except the lungs) is blocked. Children with severe or critical AS require treatment. Treatment options include balloon valvuloplasty, valve repair, or valve replacement.

Your child’s experience with balloon valvuloplasty

Balloon valvuloplasty is a heart procedure using a thin, flexible tube called a catheter. A cardiologist who has special training to use catheters to treat heart problems (cardiac catheterization) does this procedure. It lasts about 2 to 4 hours and  takes place in a catheterization lab at the hospital. You’ll stay in the waiting room during the procedure.

Before the procedure

You’ll be told to keep your child from eating or drinking anything for a certain amount of time before the procedure. Follow these instructions carefully.

During the procedure

Your doctor inflates a balloon on the tip of  catheter to open the stenotic (narrowed) aortic valve. Your child is given medicine (sedative or anesthesia). This is to help him or her relax and not feel discomfort or pain during the procedure. A breathing tube may be placed in your child’s trachea (windpipe). Special equipment monitors your child’s heart rate, blood pressure, and oxygen levels. The catheter insertion site (the groin) is cleaned and numbed. Then the catheter is inserted into a blood vessel in the groin. With the help of live X-rays, the catheter is guided up through this blood vessel into the heart. Your doctor may inject contrast dye through the catheter. The dye allows the inside of the heart to be seen on X-rays. The doctor will inflate a small balloon at the end of the catheter one or more times within the aortic valve. This forces the valve leaflets to open. Then he or she will remove  the catheter and balloon.

After the procedure

Your child is taken to a recovery room. You can stay with your child during much of this time. It may take several hours for medicines to wear off. Pressure is applied to the catheter insertion site to limit bleeding. The doctor or nurse will tell you how long your child needs to lie down and keep the insertion site still. Your child is cared for and monitored until he or she can leave the hospital. An overnight hospital stay is usually required.

Risks and complications of balloon valvuloplasty

The risks and complications include the following: 

• Reaction to contrast dye

• Reaction to sedative or anesthesia

• Pain, swelling, redness, bleeding, or drainage at the catheter insertion site

• Leakage of blood through the aortic valve back into the left ventricle (valve insufficiency)

• Abnormal heart rhythm (arrhythmia)

• The need for further treatment to repair or replace the valve

• Injury to the heart or a blood vessel

Your child’s experience with valve repair or replacement

Valve repair or replacement is done with open heart surgery. A pediatric heart surgeon does the heart surgery. The surgery lasts about 4 to 6 hours. It takes place in an operating room in a hospital. You’ll stay in the waiting room during your child’s surgery.

Before surgery

You’ll be told to keep your child from eating or drinking anything for a certain amount of time before surgery. Follow these instructions carefully.

During surgery

Your child is given medicine (sedative and anesthesia) to sleep and not feel pain during surgery. A breathing tube is placed in your child’s trachea (windpipe). Special equipment monitors your child’s heart rate, blood pressure, and oxygen levels. Your child is also placed on a heart-lung bypass machine. This allows blood to continue flowing to the body while the heart is stopped so that it can be operated on. Your surgeon will make an incision in the chest through the sternum (breastbone) to access the heart.

• With valve repair, the surgeon opens the aortic valve by cutting through thickened or fused leaflet tissue. A patch can also be used to make the valve larger, if needed.

• With valve replacement, the surgeon replaces the aortic valve with an artificial one that is either biological or mechanical. Biological valves are made from human or animal tissue. Mechanical valves are made from material such as ceramic or metal. Or, the child's own pulmonary valve may be removed and used to replace the aortic valve. This is known as the Ross procedure, which can be especially beneficial as the valve grows with your child. The pulmonary valve is then replaced with a valve from a human donor (homograft). 

After surgery

Your child is taken to a critical care unit to be cared for and monitored. You can stay with your child during much of this time. He or she will remain in the hospital for at least 5 to 7 days. When your child is ready to leave the hospital, you’ll be given instructions for home care and follow-up.

Risks and complications of heart surgery

Risks and complications may include the following:

• Reaction to sedative or anesthesia

• Leakage of blood through the aortic valve back into the left ventricle (valve insufficiency)

• Abnormal heart rhythm (arrhythmia)

• Infection

• Bleeding

• Nervous system problems, such as seizure or stroke 

• Abnormal buildup of fluid around the heart and lungs