How Long Will a Baby Live With Aortic Stenosis

Pediatric Aortic Stenosis

What is aortic stenosis?

Aortic stenosis is a heart defect that may exist present at birth (built) or information technology may develop later in life (acquired). If the trouble is congenital, then the defect developed during the beginning viii weeks of pregnancy.

The aortic valve is found betwixt the left ventricle and the aorta. It has 3 leaflets that office like a one-way door, allowing blood to flow forward into the aorta, but non backward into the left ventricle. Aortic stenosis is the disability of the aortic valve to open completely.

With aortic stenosis, problems with the aortic valve arrive harder for the leaflets to open and permit blood to flow forward from the left ventricle to the aorta. In children, these problems can include a valve that:

• Only has two leaflets instead of 3 (bicuspid aortic valve).
• Has leaflets that are partially fused together.
• Has thick leaflets that do not open all the style.
• Becomes damaged past rheumatic fever or bacterial endocarditis.
• In add-on, the area above or below the valve tin can be narrowed (supravalvar or subvalvar aortic stenosis).

Aortic stenosis may be present in varying degrees, classified co-ordinate to how much obstruction to blood catamenia is present. A child with severe aortic stenosis will be quite ill, with major symptoms noted early on in life. A kid with balmy aortic stenosis may have few symptoms, or perhaps none at all until later in adulthood. The degree of obstacle can become worse with time.

Congenital aortic stenosis occurs in a small percent of children with congenital heart affliction. Relatively few children have symptoms as an baby, but problems increase sharply in adulthood.

Congenital aortic stenosis occurs iii times more than often in boys than in girls.

• Built aortic stenosis occurs due to improper evolution of the aortic valve in the first eight weeks of prenatal growth. It can be caused past a number of factors, though, almost of the fourth dimension, this heart defect occurs sporadically (past adventure), with no apparent reason for its development.

  Some congenital heart defects may have a genetic link (defective gene), causing centre issues to occur more oftentimes in certain families.

  Caused aortic stenosis may occur after a strep infection that progresses to rheumatic fever.

• Balmy aortic stenosis may not cause any symptoms. Several issues may occur, however, when aortic stenosis is moderate to severe, including the following:

  • The left ventricle has to piece of work harder to try to move claret through the tight aortic valve. Somewhen, the left ventricle is no longer able to handle the extra workload, and it fails to pump blood to the trunk efficiently.
  • There is a higher than average chance that the aorta may become enlarged. This tin increase the risk of an aneurysm or dissection of the aorta.
  • At that place is a higher than average chance of developing an infection in the lining of the middle or aorta known every bit bacterial endocarditis.
  • The coronary arteries, which supply oxygen-rich (red) blood to the eye muscle, may not receive plenty blood to meet the demands of the heart.

• The following are the almost common symptoms of aortic stenosis. However, each child may experience symptoms differently. Symptoms may include:

  • Fatigue
  • Dizziness with exertion
  • Shortness of breath
  • Irregular heartbeats or palpitations
  • Chest hurting

  The symptoms of aortic stenosis may look similar other medical conditions or heart problems. Always consult your child'south physician for a diagnosis.

• Your child'southward medico may have heard a heart murmur during a physical test and referred your kid to a pediatric cardiologist for a diagnosis. In this case, a heart murmur is a noise acquired past the turbulence of blood flowing through the obstruction from the left ventricle to the aorta. Symptoms your child exhibits will as well aid with the diagnosis.

  A pediatric cardiologist specializes in the diagnosis and medical management of congenital heart defects, too as heart problems that may develop after in childhood. The cardiologist will do a concrete examination, heed to your child'south heart and lungs, and brand other observations that help in the diagnosis. The location within the chest that the murmur is heard all-time, as well as the loudness and quality of the murmur (harsh, bravado, etc.) will requite the cardiologist an initial idea of which eye problem your child may have. Diagnostic testing for built centre disease varies past the child's historic period, clinical condition and institutional preferences. Some tests that may be recommended include the following:

  • Chest X-ray. A test which uses X-ray beams to produce images of internal tissues, bones and organs onto film.
  • Electrocardiogram (ECG or EKG). A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle stress.
  • Echocardiogram (echo). A procedure that evaluates the structure and role of the heart past using sound waves recorded on an electronic sensor that produce a moving picture of the heart and heart valves.
  • Exercise electrocardiogram (ECG). An practice ECG is washed to assess the eye's response to stress or practice. The ECG is monitored while your child is exercising on a treadmill or stationary wheel. An EKG measures the electric action of your child's middle.
  • Cardiac MRI.A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of the heart.
  • Cardiac catheterization. A cardiac catheterization is an invasive procedure that gives very detailed information about the structures inside the heart. Under sedation, a small, thin, flexible tube (catheter) is inserted into a blood vessel in the groin and guided to the inside of the middle. Blood pressure and oxygen measurements are taken in multiple chambers of the eye, as well as the pulmonary avenue and aorta. Contrast dye is also injected to more clearly visualize the structures inside the heart.

• Specific treatment for aortic stenosis will be adamant by your child's doctor based on:

  • Your child's age, overall health and medical history
  • Extent of the affliction
  • Your kid'southward tolerance for specific medications, procedures or therapies
  • Expectations for the grade of the affliction
  • Your stance or preference

  Aortic stenosis is treated with repair of the obstructed valve. Several options are currently bachelor.

  Some infants volition be very sick, require care in the intensive care unit (ICU) prior to the process, and could possibly even need emergency repair of the aortic stenosis. Others, who accept few symptoms, will have the repair scheduled on a less urgent basis.

  Some children with severe stenosis may take action or exercise restricted prior to repair. For example, competitive sports that require endurance or intense activity, such as weightlifting, may be restricted.

  Repair options include the following:

  • Balloon dilation. A cardiac catheterization procedure in which a small, flexible tube (catheter) is inserted into a blood vessel in the groin, and guided to the inside of the heart. The tube has a deflated airship in the tip. When the tube is placed in the narrowed valve, the balloon is inflated to stretch the area open.
  • Valvotomy. This is surgical release of scar tissue inside the aortic valve leaflets that are preventing the valve leaflets from opening properly.
  • Aortic valve replacement. The aortic valve is replaced with a new valve. Replacement valves fall into ii categories: Tissue (biological) valves, which are made from animate being tissues and valves. The valve leaflets are soft and thin. On the other manus, mechanical valves, which are made from carbon fibers, have solid valve leaflets. Children who have had a valve replacement will need to follow antibody prophylaxis throughout their lifetime. People who have received a mechanical valve volition need life-long treatment with Coumadin (warfarin), a medication that thins the blood to prevent catastrophic clots from forming on the valve leaflets themselves.
  • Pulmonary autograft (Ross procedure). A section of the child's own pulmonary avenue, with the pulmonary valve intact, is used to replace the aortic valve and a section of the ascending aorta. A department of pulmonary artery from another man donor with its valve intact is used to supplant the transferred pulmonary avenue.
  • Aortic homograft.A section of aorta from a human donor, with its aortic valve intact, is used to replace the aortic valve and a section of the ascending aorta. This process is seldom done due to the complication of the operation and the rapid failure of the aortic homograft itself.

• If your child needs surgery, he or she will go to the intensive care unit of measurement (ICU) afterward the procedure. While your child is in the ICU, special equipment will be used to help him or her recover from surgery, and may include the following:

  • Ventilator.This is a machine that helps your child exhale while he or she is under anesthesia during the operation. A small, plastic tube is guided into the windpipe and attached to the ventilator, which breathes for your child while he or she is too sleepy to breathe effectively. Many children remain on the ventilator for a while later surgery and so they tin can residual.
  • Intravenous (IV) catheters. Small, plastic tubes inserted through the pare into blood vessels to provide Four fluids and of import medicines that aid your child recover from the operation.
  • Arterial line. A specialized Iv placed in the wrist or other expanse of the trunk where a pulse tin can be felt, that measures blood pressure continuously during surgery and while your child is in the ICU.
  • Nasogastric (NG) tube. A minor, flexible tube that keeps the stomach drained of acid and gas bubbling that may build up during surgery.
  • Urinary catheter.A small, flexible tube that allows urine to bleed out of the float and accurately measures how much urine the trunk makes. This can help determine how well the eye is functioning. Subsequently surgery, the heart may initially exist a piffling weaker than information technology was earlier, and, therefore, the torso may start to hold onto fluid, causing swelling and puffiness. Diuretics may exist given to help the kidneys remove excess fluid from the body.
  • Breast tube.A drainage tube may be inserted to keep the breast free of blood that would otherwise accumulate afterwards the incision is closed. Bleeding may occur for several hours or even several days after surgery.
  • Heart monitor.A motorcar that constantly displays a picture of your child'due south heart rhythm and monitors middle rate, arterial claret force per unit area and other values.

  Your kid may need other equipment not mentioned here to provide support while in the ICU or subsequently. The hospital staff will explicate all of the necessary equipment to you.

  Your child will exist kept as comfortable as possible with several different medications; some of which salvage pain and some of which relieve anxiety. The staff will also be asking for your input as to how all-time to soothe and comfort your child.

  Subsequently discharge from the ICU, your child will recuperate on another hospital unit for a few days before going home. You volition learn how to intendance for your child at dwelling before your child is discharged. Your child may demand to take medications for a while and these will be explained to you. The staff volition give you instructions regarding medications, activity limitations and follow-upwardly appointments before your child is discharged.

• About children who have had an aortic stenosis surgical repair will alive healthy lives. Activity levels, appetite and growth should eventually return to normal.

  As the child grows, a valve that was ballooned may over again go narrowed. If this happens, a second balloon procedure or operation may be necessary to repair aortic stenosis. Sometimes the aortic tissue itself may exist aberrant, which might atomic number 82 to complications in the teen or adult years. Regular follow-upwardly care at a specialized cardiac center should go along throughout life.

  Your kid'southward cardiologist may recommend that antibiotics be given to prevent bacterial endocarditis after belch from the hospital.

  People who had a mechanical valve replacement may demand to have anticoagulants (blood thinners) to foreclose blood clots from forming on the bogus valve surfaces. Regular monitoring of the blood's clotting status is very important in maintaining the most advisable dose of anticoagulants.

  Initial valve replacement is frequently done using a tissue valve to avoid the need for anticoagulation, especially for females of childbearing age. Anticoagulation during pregnancy is very difficult to manage and requires special treatment.

  Repeat valve replacement is not uncommon in the long term. In improver, blood pressure should exist closely monitored and managed.

  Consult your kid's physician near your kid's specific outlook.

Children's Team

Children'south Team

Providers

Yves d'Udekem

Sectionalisation Chief, Cardiac Surgery
Co-Managing director, Children's National Eye Institute

Departments

Departments

Cardiac Catheterization

Our heart squad performs hundreds of cardiac catheterization procedures a year, treating patients of all ages, including those with complex heart conditions.

Prenatal Cardiology Program

Our heart care begins before babies are even born, in our dedicated Prenatal Cardiology Program, where we diagnose and even treat prenatal heart conditions.

Cardiac Surgery

Our pediatric middle surgery team performs twice the number of surgeries of whatsoever other hospital in the region, with some of the best outcomes in the nation.

Children'due south National Heart Institute

Our good pediatric heart team, including more than forty subspecialties, offer advanced heart care and excellent outcomes for thousands of children every year.

Cardiology

The pediatric heart experts at Children's National Infirmary in Washington, D.C., provide advanced care for unborn babies, children and young adults with centre conditions.

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Source: https://childrensnational.org/visit/conditions-and-treatments/heart/aortic-stenosis

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