Treatments for aortic valve stenosis in children

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Contact the Congenital Heart Valve Program

Boston Children's Hospital's cardiologists, cardiac surgeons and nurses, cardiac imaging professionals and other clinicians have years of expertise in treating all types of heart defects and heart disease, with specialized understanding of problems like aortic valve stenosis that affect the valves of the heart. 

Our team treats every stage of aortic valve stenosis in children, adolescents and adults, as well as babies in utero. We use minimally invasive techniques—medical and surgical procedures that use small incisions and miniaturized cameras and tools—whenever we can, and are committed to repairing a child's own valve rather than resorting to an entire valve replacement whenever possible. Boston Children's Interventional Catheterization Program has made great strides in allowing children to keep their own heart valves for as long as possible during treatment.

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

Treatments for aortic valve stenosis

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 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 in order to prevent an infection called bacterial endocarditis, even if his 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, he probably will not need antibiotics before a routine dental procedure (for example, a teeth-cleaning).

Learn more about commonly prescribed medications only.

Interventional catheterization/balloon valvuloplasty

Boston Children's has a comprehensive program dedicated to interventional catheterization, the use of a thin tube called a catheter that 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. With a 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 replacement surgery

For children with severe aortic valve stenosis, balloon valvuloplasty may not be able to 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 begins to narrow again, adding strain to the heart and affecting blood flow throughout the body. Replacement of the aortic valve is the next step in treatment for these children.

During this procedure, cardiac surgeons will remove the damaged aortic valve and replace it with either

  • a mechanical valve, made of metal and other synthetic materials. 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 this procedure, so children are typically prescribed a blood-thinning medication to prevent complications.

or

  • a donor valve taken from a human or animal donor (sometimes, new valves can even be fashioned from the child's own tissue). This type of procedure is a more recent advance, and the long-term durability of donor valves is still being determined. The results, however, look promising. Donor valve replacement does not appear to be associated with any notable risk of blood clot formation, so children normally do not need blood-thinning medications after this variation of the surgery.

Both types of valve replacement surgery have an excellent success rate and a low incidence of complications. Children who undergo either type of valve replacement procedure are likely to enjoy normal, healthy adult lives with minimal to no restrictions on playing sports or engaging in other strenuous activities. 

After valve replacement surgery

Most children need to stay in the hospital for a week to 10 days after valve replacement surgery, and will need another three to six weeks of rest at home before returning to their normal daily activities.

Children with implanted valves—just like children with aortic valve stenosis, in general—can be more susceptible to bacteria entering the bloodstream. The bacteria can cause a serious infection called bacterial endocarditis. As a result, these children might need a regimen of antibiotics before undergoing some medical procedures. If your child has undergone valve replacement surgery, you should always inform medical personnel of your child's condition before arranging for any procedure.

It is likely that your child will need another valve replacement surgery within 20 years as the donor valve ages. 

Coping and support

When your child is living with aortic valve stenosis, your family may have many concerns, worries and questions. Not only are you focused on meeting all of your child's medical needs; you are also grappling with a significant emotional and psychological toll that can affect every member of the family.

In addition to the clinical information offered on this page, Children's has several other resources designed to give your family comfort, support and guidance:

  • Boston Children's Behavioral Medicine Clinic helps kids who are being treated on an outpatient basis at the hospital—as well as their families—understand and cope with their feelings about:
    • being sick
    • facing uncomfortable procedures
    • handling pain
    • taking medication
    • preparing for surgery
    • changes in friendships and family relationships
    • managing school while dealing with an illness
    • grief and loss
  • The Cardiac Experience Journal was designed by Boston Children's psychiatrist-in-chief David DeMaso, MD, and members of his team. This online collection features thoughts, reflections and advice from kids and caregivers about going through cardiac disease, heart transplants and many other medical experiences.

  • Boston Children's Psychiatry Consultation Service is comprised of expert and compassionate pediatric psychologists, psychiatrists, social workers and other mental health professionals who understand the unique circumstances of hospitalized children and their families. The team provides several services, including:
    • short-term therapy for children admitted to one of our inpatient units
    • parent and sibling consultations
    • teaching healthy coping skills for the whole family
    • educating members of the medical treatment team about the relationship between physical illness and psychological distress;
  • Boston Children's Department of Psychiatry offers a free booklet, “Helping Your Child with Medical Experiences: A Practical Parent Guide” (Adobe Acrobat is required). Topics in the booklet include:
    • talking to your child about his or her condition
    • preparing for surgery and hospitalization
    • supporting siblings
    • taking care of yourself during your child's illness
    • adjusting to life after treatment
  • Boston Children's Center for Families is dedicated to helping families locate the information and resources they need to better understand their child's particular condition and take part in their care. All patients, families and health professionals are welcome to use the center's services at no extra cost. The center is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.
     
  • The Boston Children's chaplaincy is a source of spiritual support for parents and family members. Our program includes nearly a dozen clergy members—representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions—who will listen to you, pray with you and help you observe your own faith practices during your child's treatment.

  • For children and families affected by life-threatening illness, our Pediatric Advanced Care Team (PACT) is available to provide supportive treatments intended to optimize the quality of life and promote healing and comfort. In addition, PACT can provide emotional support and help arrange end-of-life care when necessary. Please call 617-632-5042 for more information.

  • Boston Children's Integrative Therapies Team provides a number of services for hospitalized children, their families and their caregivers, including:
    • massage therapy
    • acupuncture
    • yoga
    • therapeutic touch
  • Boston Children's International Center is a dedicated resource for patients and families from countries outside the United States. The center can provide assistance with everything from reviewing medical records to setting up appointments and locating lodging. Contact the center by phone at 01-617-355-5209 or via e-mail at international.center@childrens.harvard.edu.

Helpful links

Please note that neither Boston Children's Hospital nor the Department of Cardiology at Boston Children's unreservedly endorses all of the information found at the sites listed below. These links are provided as a resource.

Helpful links for parents and families

Helpful links for teens

Helpful links for younger children

We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital
300 Longwood Avenue, Boston, MA 02115
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