Congenital Aortic Valve Stenosis in Children: Understanding Causes, Symptoms, and Treatment Options

Congenital aortic valve stenosis is a heart condition that affects infants and children, characterized by an abnormal development of the aortic valve. This narrowing restricts blood flow from the heart to the rest of the body. One of the most common causes of this condition is a bicuspid aortic valve, where the valve only has two flaps instead of the usual three.

Classification of Aortic Valve Stenosis

Depending on the severity of the blockage, congenital aortic stenosis can be classified into three categories: mild, moderate, and severe. Typically, a mean pressure gradient exceeding 50 mmHg across the valve indicates severe stenosis. These classifications help doctors determine the appropriate treatment and long-term management strategies for each patient.

Impact on the Heart and Development

In children with this condition, the left ventricle must work harder to pump blood through the narrowed valve. Over time, this increased workload can lead to left ventricular hypertrophy — a thickening of the heart muscle. In some cases, changes may also appear on an electrocardiogram (ECG), indicating abnormal heart activity due to the added stress on the heart.

Symptoms Across Different Ages

Children with mild aortic stenosis often show no symptoms during early childhood. However, as they age — typically between 40 and 50 years old — the valve may begin to calcify or become scarred, leading to worsening stenosis. This progression highlights the importance of long-term monitoring, even in patients who appear asymptomatic during childhood.

When Is Treatment Necessary?

Medical intervention becomes necessary when a child's systolic pressure exceeds 90 mmHg or when the mean pressure gradient is above 50 mmHg, especially if left ventricular hypertrophy is present. In such cases, surgical options like balloon valvuloplasty or valve replacement may be recommended to restore normal blood flow and prevent further damage to the heart.

Conclusion

Congenital aortic valve stenosis requires careful evaluation and ongoing care. Early diagnosis and timely treatment can significantly improve outcomes, helping affected children lead healthy, active lives. Parents should work closely with pediatric cardiologists to develop a comprehensive care plan tailored to their child's specific needs.