AORTIC STENOSIS

What is Aortic Stenosis?

Aortic stenosis is a heart defect that may be present at birth
(congenital) or it may develop later in life (acquired). If the
problem is congenital, then the defect developed during the
first 8 weeks of pregnancy
 What is Aortic Stenosis?-con’t
The aortic valve is found between the left ventricle and the aorta. It
has 3 leaflets that function like a one-way door, allowing blood to flow
forward into the aorta, but not backward into the left ventricle. Aortic
stenosis is the inability of the aortic valve to open completely.
 What is Aortic Stenosis?-con’t
With aortic stenosis, • Only has two leaflets instead of three
problems with the aortic (bicuspid aortic valve).
valve make it harder for • Has leaflets that are partially fused
together.
the leaflets to open and • Has thick leaflets that do not open all
permit blood to flow the way.
forward from the left • Becomes damaged by rheumatic fever
or bacterial endocarditis.
ventricle to the aorta. In
• In addition, the area above or below the
children, these valve can be narrowed (supravalvar or
problems can include a subvalvar aortic stenosis).
valve that:
 What causes Aortic Stenosis?
Congenital aortic stenosis occurs due to improper development of the aortic
valve in the first 8 weeks of fetal growth. most of the time, this heart defect
occurs sporadically (by chance), with no apparent reason for its development.

Some congenital heart defects may have a genetic link (defective gene),
causing heart problems to occur more often in certain families.

Acquired aortic stenosis may occur after a strep infection that progresses to
rheumatic fever.
What are the Sign/Symptoms of Aortic Stenosis?

The following are the most common symptoms of aortic stenosis.

However, each child may experience symptoms differently.
Symptoms may include:
Fatigue
Dizziness with exertion
Shortness of breath
Irregular heartbeats or palpitations
Chest pain
 Why is Aortic Stenosis a concern?
chance of The coronary
The left ventricle is Might increase the developing an arteries may not
no longer able to risk of an aneurysm infection in the lining receive enough
handle the extra or dissection of the of the heart or aorta blood to meet the
workload aorta. known as bacterial demands of the
endocarditis. heart.

When aortic stenosis is moderate

to severe, including the following:
How is Aortic Stenosis diagnosed?

Electrocardiogram Echocardiogram Cardiac

Chest X-ray Cardiac MRI
(ECG or EKG) (echo) catheterization
 Treatment for Aortic Stenosis
Aortic
stenosis is
treated with • Balloon dilation.
repair of the • Valvotomy.
obstructed • Aortic valve replacement.
valve. • Pulmonary autograft (Ross
Several procedure).
options are • Aortic homograft.
currently
available.
Balloon Dilation

A cardiac catheterization
procedure in which a small,
flexible tube (catheter) is inserted
into a blood vessel in the groin,
and guided to the inside of the
heart. The tube has a deflated
balloon in the tip. When the tube
is placed in the narrowed valve,
the balloon is inflated to stretch
the area open.
Valvotomy

This is surgical
release of scar tissue
within the aortic valve
leaflets that are
preventing the valve
leaflets from opening
properly.
Aortic Valve Replacement
The aortic valve is replaced with a new valve.
Replacement valves fall into two categories:
Tissue (biological) valves, which are made from
animal tissues and valves. The valve leaflets
are soft and thin. On the other hand,
mechanical valves, which are made from
carbon fibers, have solid valve leaflets.
Children who have had a valve replacement
will need to follow antibiotic prophylaxis
throughout their lifetime. People who have
received a mechanical valve will need life-long
treatment with Coumadin (warfarin), a
medication that thins the blood to prevent
catastrophic clots from forming on the valve
leaflets themselves.
Pulmonary Autograft (Ross procedure)

A section of the child's own

pulmonary artery, with the
pulmonary valve intact, is used
to replace the aortic valve and
a section of the ascending
aorta. A section of pulmonary
artery from another human
donor with its valve intact is
used to replace the transferred
pulmonary artery.
Aortic Homograft

A section of aorta from a

human donor, with its aortic
valve intact, is used to replace
the aortic valve and a section
of the ascending aorta. This
procedure is seldom done due
to the complexity of the
operation and the rapid failure
of the aortic homograft itself.
COARCTATION
OF AORTA
 DEFINITION
• Coarctation= narrowing
 SIGN & SYMPTOM
• Lower extremities Cyanosis; Blue or Purple discoloration (ofen present at
birth)
 TREATMENT
Surgically removal of
Balloon Dilatation coarctation
NURSING INTERVENTION

????
SUMMARY
 Nursing Diagnosis
Decreased Cardiac Output

Activity Intolerance

Compromised Family Coping

Risk for Injury

Risk for Infection

 EXPLANATION OF COA
CONTINUE’
COARCTATION OF AORTA
What is COA ?
• Coarctation of the aorta is a narrowing of the aorta, the main blood vessel carrying oxygen-
rich blood from the left ventricle of the heart to all of the organs of the body.
• Coarctation occurs most commonly in a short segment of the aorta just beyond where the arteries to
the head and arms take off, as the aorta arches inferiorly toward the chest and abdomen.
• This portion of the aorta is called the "juxtaductal" aorta, or the part near where the ductus arteriosus
attaches. It is also called the aortic isthmus.
• The ductus arteriosus is a blood vessel that is normally present in a fetus and has special tissue in its
wall that causes it to close in the first hours or days of life. Coarctation may be caused by the
presence of extra ductal tissue extending into the adjacent aorta which results in aortic narrowing as
the ductal tissue contracts.
What is COA ?-con’t
• In babies with coarctation, the aortic arch may also be
small (hypoplastic). Coarctation may also occur with
other cardiac defects, typically involving the left side of
the heart. The defects most commonly seen with
coarctation are bicuspid aortic valve and ventricular
septal defect. Coarctation may also be seen as a part of
more complex single ventricle heart defects.
What is COA ?-con’t
• Coarctation of the aorta is common in some patients with chromosomal abnormalities, such
as Turner's syndrome.
• In the presence of a coarctation, the left ventricle has to work harder, since it must
generate a higher pressure than normal to force blood through the narrow segment of aorta
to the lower part of the body.

• If the narrowing is very severe, the ventricle may not be strong enough to perform this extra
work, resulting in congestive heart failure or inadequate blood flow to the organs of the
body.
Diagnosis of COA

The diagnosis of coarctation is usually

confirmed with echocardiography, which
can define the anatomy of the aorta and
evaluate for other cardiac anomalies
that may also be present. Occasionally
other tests, such as a cardiac MRI or CT
scan, may be used to document the
presence of a coarctation.
Management of COA

In a critically ill new-borns, the goals of management are to improve ventricular function and
restore blood flow to the lower body.

A continuous intravenous medication, prostaglandin (PGE-1), is used to open the ductus

arteriosus (and maintain it in an open state) allowing blood flow to the body beyond the
coarctation.

It is also often necessary to begin intravenous medications that improve the contraction of the
heart muscle. Babies will almost always need to be placed on a ventilator before surgery