Aortic Valve Stenosis | Treatments

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What are the treatment options for aortic valve stenosis?

Your child's exact treatment plan will be determined by age, the extent of narrowing in the aortic valve and overall health.

Monitoring

Children with mild to moderate aortic valve stenosis may not require any treatment other than routine monitoring in the short term. Your child's cardiologist will regularly evaluate your child for any sign of further narrowing in the aortic valve and related complications. Most often, routine monitoring will involve physical examinations and echocardiograms.

Medication

Medication is not a cure for aortic valve stenosis, but it can be helpful in managing specific symptoms. In some cases, your child's clinician may prescribe medication to:

  • help the heart maintain healthy function and blood flow
  • control blood pressure
  • prevent abnormal heart rhythms, called arrhythmias

A child with aortic valve stenosis may also need to periodically take antibiotics to prevent an infection called bacterial endocarditis, even if the aortic valve has been surgically replaced. Bacterial endocarditis can cause serious damage to the inner lining of the heart and its valves. You should always let medical personnel know about your child's aortic valve stenosis before making arrangements for a medical procedure, even if the procedure seems minor or unrelated to your child's cardiac care.

If your child has aortic valve stenosis, but no other cardiac problems, antibiotics will likely not be needed before a routine dental procedure, such as teeth cleaning.

Interventional catheterization/balloon valvuloplasty

Interventional catheterization is a minimally-invasive procedure. During a catheterization, a thin tube, called a catheter, is threaded from a vein or artery into the heart. This catheter can be used to fix holes in the heart, open narrowed passageways (like the aortic valve) and create new passageways.

Recognizing the benefits of this minimally invasive treatment — less discomfort, shorter recovery periods and the use of the child's own valve, which will grow with the child after the procedure — Boston Children's considers interventional catheterization the preferred frontline approach to aortic valve stenosis.

The most common interventional catheterization procedure used to treat aortic valve stenosis is balloon dilation, also known as balloon valvuloplasty. While the child is under sedation, a small, flexible catheter is inserted into a blood vessel, most often in the groin. Using tiny, highly precise cameras and tools, clinicians guide the catheter up into the inside of the heart and across the aortic valve. A deflated balloon at the tip of the catheter is inflated once the tube is in place, and this balloon stretches the aortic valve open, reversing the problematic narrowing.

Valve repair or replacement surgery

For children with severe aortic valve stenosis, balloon valvuloplasty may not adequately fix the narrowed valve and restore healthy heart function. In other cases, as the child grows, an aortic valve that was previously treated successfully with one or more balloon-dilation procedures may begin to narrow again, adding strain to the heart and affecting blood flow throughout the body. Repair or replacement of the aortic valve is the next step in treatment for these children.

For all patients, we make every effort possible to repair the aortic valve. This may involve leaflet sculpting (valvuloplasty) or leaflet replacement. Boston Children’s has extensive experience with the latest advances in aortic valve repair, including the Ozaki procedure.

When repair is not possible, cardiac surgeons will remove the damaged aortic valve and replace it with a mechanical or tissue valve. Mechanical valves can last for more than 20 years before needing to be replaced. There is a small risk of blood clot formation associated with mechanical valves, so typically children are prescribed a blood-thinning medication to prevent complications. Tissue valves do not require the same blood-thinning medication, although they may not last as long as mechanical valves.

Another valve-replacement option is to replace the aortic valve with the child’s own pulmonary valve (Ross procedure). This approach avoids the need for blood thinners.

When valve replacement is necessary, the valve selected will be based on the individual needs and circumstances of the child. All types of valve-replacement surgery have excellent success rates and a low incidence of complications. Children who have valve-replacement procedures are likely to enjoy normal, healthy lives with minimal to no restrictions on playing sports or engaging in other activities. Most children need to stay in the hospital for a week to 10 days after valve repair or replacement surgery and will return to their normal activities quickly.

Boston Children’s is so much more than a hospital—it’s a community of researchers, clinicians, administrators, support staff, innovators, teachers, patients and families, all working together to make the impossible possible. ”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital
300 Longwood Avenue, Boston, MA 02115
For Patients: 617-355-6000
For Referring Providers: 844-BCH-PEDS | 844-224-7337

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