What Is Aortic Valve Disease?

The aortic valve is one of four valves (tissue flaps) in the heart that are vital to its normal function. With each heartbeat, the tissue flaps open and shut, working in concert with contraction and relaxation of the heart chambers to propel blood through the heart’s four chambers and to the rest of the circulation.

Heart valves keep blood flowing in a forward direction. The normal heart has four valves:

Left Side

  • Mitral valve - allowing flow from left atrium to left ventricle
  • Aortic valve - allowing flow from left ventricle to body circulation

Right Side

  • Tricuspid valve - allowing flow from right atrium into right ventricle
  • Pulmonary valve - allowing flow from right ventricle to lung circulation

A hardened or fused valve, also known as aortic stenosis, leads to obstruction, forcing the left ventricle (the heart’s lower left chamber) to work harder to pump blood into the aorta.

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A leaky aortic valve, also called aortic insufficiency (otherwise, called aortic regurgitation), is a valve that does not shut properly. Therefore, blood leaks back into the left ventricle. The ventricle enlarges in response to accommodate the leaking volume of blood in excess of the usual volume of blood, forcing it to use more effort to expel blood into the body.

Some valve defects have both problems. A stiff valve partially obstructs blood flow from the heart, but since it also does not close properly, blood leaks.

These defects overtax the left ventricle and, with time, the ventricle can fail to perform properly.

What Are the Causes Aortic Valve Disease?

Many valve defects occur before birth. Aortic valve disease can be congenital (a child is born with the valve problem) or it may be acquired later in life. A normal aortic valve has three “cusps” or leaflets. Some children are born with a bicuspid valve having only two leaflets. Often times, a bicuspid valve does not require any intervention until much later in adulthood.

Untreated strep throat can develop into rheumatic fever, which in turn, can scar the valve. That is why taking a full course of prescribed antibiotics is vital to treat these symptoms.

How Is Aortic Valve Disease Diagnosed?

In infants, lethargy, poor feeding (or poor food intake) and difficulty breathing may signal a valve problem. Rarely, fainting or chest pain also may indicate a problem for older children.

Though valve disease may have no warning signs, doctors may hear an odd, whooshing sound (or heart murmur) via stethoscope. The following tests may be utilized to find more details:

  • An electrocardiogram (EKG or ECG) can check the heart’s electrical action to reveal damage or irregular rhythms.
  • Chest X-rays create images of the heart and lungs and can show fluid in the lungs due to valve defects.
  • An echocardiogram (echo) uses sound waves (ultrasound) to produce images of the heart and vessels on a screen that reveals whether the heart is pumping properly.
  • A cardiac MRI (magnetic resonance imaging) uses radio waves, magnets and a computer to form three-dimensional images of the heart, which can reveal structural abnormalities.
  • Cardiac catheterization involves a thin, long tube that is inserted into a blood vessel – usually from the groin – and guided into the heart to obtain direct pressure measurements and angiograms (X-ray images of the heart chambers and valves). It may provide therapy for aortic valve stenosis using balloon-tipped catheters (balloon aortic valvuloplasty).

How Aortic Valve Disease Treated?

Aortic valve repair is possible occasionally, although this is uncommon. Young children with aortic stenosis can have their valves opened, either by a balloon procedure or by open surgery; however, this may not always be performed successfully. Older children and young adults can rarely have aortic stenosis repaired surgically. Even less commonly, aortic insufficiency can be repaired surgically. Thus, most people who have significant aortic valve problems require aortic valve replacement.

There are many types of replacement valves – each comes with its own set of advantages and disadvantages. In the table below, the term anticoagulation refers to the need to take "anticlotting" medications. It is imperative that patients maintain careful follow-up so the amount of medication they receive is correct, and sometimes their lifestyle needs to be modified.

Valve Type Advantage Disadvantage

Mechanical

  • Lasts a long time
  • Straightforward to implant
  • Needs anticoagulation
  • Does not grow

Tissue Valve

  • Straightforward to implant
  • Does not need anticoagulation
  • Limited longevity
  • Does not grow

Homograft (human cadaver valve)

  • Does not need anticoagulation
  • Limited longevity
  • Does not grow
  • Complex to implant

Ross Procedure (autograft)

  • Does not need anticoagulation
  • May last for decades
  • Complex to implant
  • Still may require future operations

Aortic valve disease affects each child differently. Your physician is always your best resource for providing you with the best treatment options specific to your child’s condition.

Why Choose the Children’s Heart Institute?

At Children’s Heart Institute at Children’s Memorial Hermann Hospital, patients with congenital or acquired heart disorders receive hands-on specialized care 24/7 from a team of affiliated physicians and specialty-trained nurses who aim to deliver the best possible outcomes.

Children’s Memorial Hermann Hospital was named one of the top 50 best children's hospitals nationally in Cardiology & Heart Surgery by U.S. News & World Report, and Children’s Heart Institute earned the distinguished three-star rating from The Society of Thoracic Surgeons (STS) for patient care and outcomes in congenital heart surgery. As one of only 12 three-star programs, Children’s Heart Institute ranks among the elite in the United States and Canada for congenital heart surgery.

In collaboration with various subspecialties, the affiliated team provides comprehensive care for newborns, children and adolescents, with the ability to transition into adult congenital cardiac care. Team members have the experience and skills necessary to offer innovative treatment methods and specialized services, including, but not limited to:

  • Biventricular repairs and biventricular conversions
  • Congenital heart optimization
  • Full repairs for complex congenital heart defects in newborns
  • Hybrid catheterization and surgical procedures
  • Minimally invasive transcatheter pulmonary valve (TPV) therapy
  • Minimally invasive axillary repair (cosmetic right axillary thoracotomy for transatrial repair)
  • Treatment for adult congenital heart disease
  • Valve repairs and preservation

With the Level IV Neonatal Intensive Care Unit (NICU) and a dedicated Children’s Heart Institute Intensive Care Unit at Children’s Memorial Hermann Hospital, critical heart patients have access to quality, specialized care. By utilizing state-of-the-art techniques, the team at Children’s Heart Institute strives to offer patients with the most complex problems the greatest opportunity for a normal life.

Contact Us

If you have any questions, use the online tool below to help us connect with you. To refer a patient or schedule an appointment, please contact our clinic using the information below.

  • Pediatric Cardiology Clinic
    The University of Texas Health Science Center Professional Building
    6410 Fannin, Suite 370
    Houston, TX 77030
    Phone: (713) 486-6755 (Appointment Line)
     
  • Pediatric and Congenital Heart Surgery Clinic
    The University of Texas Health Science Center Professional Building
    6410 Fannin, Suite 370
    Houston, TX 77030
    Phone: (713) 500-5746
    CMHH-Heart@memorialhermann.org

To contact Children’s Heart Institute at Children’s Memorial Hermann Hospital, please fill out the form below.

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The Children’s Heart Institute at Children’s Memorial Hermann Hospital is affiliated with the physicians at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and the UT Physicians Pediatric Outpatient Clinics across Greater Houston. Affiliated physicians evaluate patients at UT Physicians clinic locations and perform all inpatient procedures and treatments at Children’s Memorial Hermann Hospital.