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Cardiology

Aortic Stenosis AS

  • The Aortic Valve is thickened and narrowed leading to the development of abnormally high pressure in the left ventricle. The left ventricular wall becomes thickened ("Hypertrophied"). If the problem is severe it may require treatment, which usually involves surgery in younger patients, though it may be possible to stretch the valve with a balloon catheter (Balloon Valvuloplasty), in older children. The catheter is passed from an artery in the leg. When the tip is through the valve the balloon is inflated to open the valve. Treatment does not completely cure the problem and the valve sometimes tends to develop further problems with time, sometimes needing reoperation or further balloon stretching.

    If the valve is severely abnormal a valve replacement may be required.

    Subaortic Stenosis - In this condition the obstruction is below the valve

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    2b_Aortic_stenosis_AS

    Subaortic Stenosis

    In this condition the narrowing is below the aortic valve (indicated by arrow). The effect on heart function is similar to aortic valve stenosis. In many cases the obstruction is produced by a 'membrane', but other types of subaortic stenosis also occur - notably a 'muscular' type (also called "Hypertrophic Obstructive Cardiomyopathy" (HOCM) or "Idiopathic Hypertrophic Subaortic Stenosis"  (IHSS).

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    Aortic Valve Replacement

    When the aortic valve is very abnormal and if it cannot be effectively repaired a valve replacement operation may be recommended. This may involve the use of an artificial valve, but in many cases the patient's own normal Pulmonary valve can be used. This is called the 'Ross Operation' (or Pulmonary Autograft).

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    Ross Operation

    The healthy Pulmonary Valve is removed and sewn into the position of the damaged Aortic Valve. The Pulmonary Valve itself is then replaced with a 'Homograft Valve'. The advantage of this operation is that the new aortic valve will grow with the child and the Homograft Valve, which can be large enough to allow for growth, is not subjected to high pressure and can last much longer in the position of the low pressure Pulmonary Valve - though it is likely that it will eventually need to be replaced at a further operation.

     

     
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