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Aortic stenosis in children (Clinical presentation (Asymptomatic,…
Aortic stenosis
in children
Definition
Congenital narrowing
of the aortic valve
Epidemiology
Rare
Often associated with MS and
coarctation of the aorta
Pathophysiology
Defect
Aortic valve leaflets partly fused
(1-3 leaflets)
Mechanism
Restrictive blood exit from RV
Reduced oxygen supply to tissues, worse on increased demand e.g. exercise (i.e. exercise intolerance)
Also reduced oxygen supply to CA circulation,
causing pain on exertion (angina)
Clinical
presentation
Asymptomatic
Reduced exercise tolerance
Chest pain
(on exertion)
Diagnosis
Examination
Cardio
Pulse (small vol, slow rising)
Carotid thrill
Murmur (ejection systolic, URSE,
radiates to carotids)
Investigations
Bloods
FBC, U+E, LFT
Imaging
CXR: nil, or cardiomegaly and
dilated ascending aorta
ECHO: diagnostic
Bedside
Obs (sats, RR, HR, BP, temp)
ECG (LVH)
History
PMH
Growth and development
Vaccinations
Known conditions
DH
Meds, allergies
POH
Antenatal: bloods, scans, growth
Perinatal: gestation, delivery, weight
Postnatal: growth, complications
FH
Heart conditions
Cosanguinuity
PC/HPC
SOB exertion, chest pain
SH
Living arrangements,
school/nursery
Management
Surgical
Valvotomy
Indication: symptomatic older children
MOA: balloon valvotomy of aortic valve
to widen the valve
Valvectomy
Indication: significant AS
MOA: replacement of valve
Conservative
Information, advice, support
Refer to cardio/paeds
Complications
Heart failure
Increased backpressure on LV
and hypertrophy over time
Screening
Antenatal screening programme
Foetal anomaly screening
Neonatal examination
Murmur
