What Are Aortic Valve Diseases in Children? The aortic valve is located between the left ventricle of the heart and the aorta, the main artery that carries blood to the body. In a normal heart, the aortic valve opens as the heart contracts, allowing blood to pass to the body. When the heart relaxes, it closes and prevents blood from flowing backward. When the structure or function of the aortic valve is impaired in children, blood circulation can be affected. Aortic valve diseases are generally evaluated in two main groups: - Aortic valve stenosis: Blood passage to the body becomes difficult because the valve cannot open sufficiently. - Aortic valve regurgitation: Blood leaks back from the aorta into the left ventricle because the valve cannot close completely. Some children may have both stenosis and valve regurgitation together. Why Do Aortic Valve Diseases Occur in Children? Aortic valve diseases in children are mostly congenital. One of the most common causes is the aortic valve developing with two leaflets when it should normally have three. This is called a bicuspid aortic valve. Other causes include: - Congenital structural valve abnormalities - Valve leaflets that are fused together - Heart infections - Rheumatic heart disease - Connective tissue diseases - Previous heart procedures The cause and the rate of progression of the disease may be different in every child. What Are the Symptoms of Aortic Valve Diseases in Children? Symptoms vary according to the type and severity of the valve disease. Mild valve diseases may cause no symptoms for a long time. In moderate and advanced valve problems, the following symptoms may be seen: - Tiring quickly and weakness - Shortness of breath during exercise - Chest pain - Dizziness or fainting - Palpitations - Feeding difficulty in infants - Inadequate weight gain - Signs of heart failure in advanced cases Fainting, chest pain, or marked shortness of breath during exercise in particular requires medical evaluation without delay. What Is Aortic Valve Stenosis? Aortic valve stenosis is difficulty in the flow of blood leaving the heart because the valve leaflets cannot open sufficiently. In this case, the left ventricle has to generate higher pressure than normal to send blood to the body. Over time, thickening of the heart muscle may develop. In severe stenosis, the pumping function of the heart may be affected. Critical aortic stenosis, especially when seen in the newborn period, may require emergency intervention. What Is Aortic Valve Regurgitation? Aortic valve regurgitation is the return of part of the blood to the left ventricle because the aortic valve cannot close completely. This causes the left ventricle to work with more blood volume than normal. In severe valve regurgitation that continues for a long time, the left ventricle may enlarge and heart function may deteriorate over time. The treatment decision is determined according to the degree of the valve leak and its effects on the heart. How Are Aortic Valve Diseases Diagnosed in Children? Aortic valve diseases are diagnosed through examination and imaging methods performed by a pediatric cardiology specialist. 1. Physical Examination A heart murmur heard in the heart may be one of the first signs of aortic valve disease. 2. Echocardiography (ECHO) This is the basic diagnostic method that evaluates the structure of the aortic valve, the degree of stenosis or leakage, and the function of the left ventricle. 3. Electrocardiography (ECG) Heart rhythm and findings related to strain on the heart chambers are examined. 4. Cardiac MRI In some patients, it may be used to evaluate in detail the amount of valve leakage, the volume of the left ventricle, and the structure of the aorta. 5. Cardiac Catheterization When necessary, it may be used to evaluate pressures within the heart or to perform interventional treatment. In Which Situations Do Aortic Valve Diseases in Children Require Surgery? Surgery is not necessary in every aortic valve disease. Children with mild stenosis or regurgitation and normal heart function are generally followed with regular cardiology check-ups. However, intervention may be needed in the following situations: - Advanced aortic valve stenosis - Severe aortic valve regurgitation - Deterioration in left ventricular function - Marked enlargement of the heart chambers - Chest pain or fainting during exercise - Signs of heart failure - Progression of the valve disease during follow-up The treatment decision is determined according to the child's age, valve anatomy, symptoms, and imaging results. Treatment Options for Aortic Valve Diseases in Children The main aim of treatment is to regulate blood flow from the heart to the body, improve valve function, and prevent damage to the heart muscle. The method to be used varies according to the type and severity of the valve disease. 1. Balloon Aortic Valvuloplasty Balloon aortic valvuloplasty is an interventional treatment method used in children with suitable aortic valve stenosis. In this procedure, the aortic valve is reached with the help of a thin catheter advanced through a groin vein. The narrowed valve opening is widened by inflating the balloon at the tip of the catheter. This method does not require open-heart surgery and is an important treatment option, especially in congenital aortic valve stenosis. However, valve regurgitation may develop after the procedure, or re-narrowing may be seen over time. Important: Balloon valvuloplasty is not used to treat aortic valve regurgitation. 2. Surgical Aortic Valve Repair In some children, it may be possible to preserve the natural structure of the aortic valve. In surgical valve repair, the aim is to help the valve open better or close better. During the operation: - Valve leaflets that are fused together may be separated. - Thickened valve tissues may be adjusted. - The closure of the valve leaflets may be improved. - When necessary, the valve structure may be reshaped. Preserving the natural valve can provide important advantages, especially in children who are still growing. However, not every valve anatomy is suitable for repair. 3. Ross Operation The Ross operation is a special valve replacement method that may be considered particularly in selected children and young patients. In this operation, the patient's own pulmonary valve is moved to the position of the aortic valve. A suitable valved conduit is placed in the pulmonary valve area. One of the important advantages of the Ross operation is that the living valve moved to the aortic position has the potential to grow with the child. In addition, in suitable patients, lifelong blood thinner use, which is specific to mechanical valves, may not be needed. However, this operation is a complex surgical procedure. In later years, reintervention may be needed in both the aortic and pulmonary valve areas. 4. Mechanical Aortic Valve Replacement In some children whose aortic valve cannot be repaired, a mechanical valve may be used. Mechanical valves can function for a long time thanks to their durable structure. However, patients with a mechanical valve generally need to use blood thinner medication for life and have regular clotting tests. In addition, as the child grows, reoperation may be needed because the valve size becomes insufficient. 5. Biological Aortic Valve Replacement In some patients, biological valves may be preferred. One of the important advantages of biological valves is that, in most cases, they do not require lifelong blood thinners compared with mechanical valves. However, biological valves may wear out faster, especially in children. For this reason, valve replacement may be needed again in later years. The choice of valve type is made by taking into account the child's age, growth potential, and general health. Is Aortic Valve Repair or Valve Replacement More Suitable? In children, preserving the natural aortic valve may be preferred whenever possible. However, valve replacement may be needed in patients with serious valve deformity or in whom adequate function cannot be achieved with repair. The following are evaluated together when choosing treatment: - The child's age and weight - The condition of the valve leaflets - The degree of stenosis or leakage - Left ventricular function - The child's growth potential - Previous heart operations The most suitable surgical method may be different for every child. Is Aortic Valve Surgery in Children Risky? Aortic valve operations are important operations performed by experienced pediatric heart surgery teams. The level of risk varies according to the child's age, the severity of the valve disease, heart function, and the surgical method to be used. Possible complications include: - Bleeding and infection - Heart rhythm disorders - Valve leakage or re-narrowing - Deterioration in heart function - Clot formation - The need for additional surgical intervention Long-term follow-up is especially important in children who have had valve replacement. Recovery Process After Aortic Valve Surgery After surgery, children are closely monitored in the pediatric heart surgery intensive care unit. During this period, heart function, breathing, blood pressure, and heart rhythm are evaluated. During the recovery process: - The functioning of the aortic valve is checked. - Heart function is evaluated with echocardiography. - Necessary medication treatments are arranged. - The healing of the surgical wound is monitored. - Nutrition and physical activity are planned. - Follow-up examinations are scheduled. The length of hospital stay and recovery may vary according to the extent of the operation. Can Children Live Normally After Aortic Valve Surgery? After successful treatment, many children can show normal growth and development. Children can continue their school life and take part in physical activities in line with the cardiology specialist's recommendations. However, aortic valve diseases may require regular follow-up even after treatment. In children who have had valve replacement in particular, valve mismatch related to growth, deterioration in valve function, or the need for reintervention may arise. For this reason, long-term pediatric cardiology check-ups are important. Why Is Early Diagnosis Important in Aortic Valve Diseases in Children? When aortic valve diseases are detected early, the effects of stenosis or valve leakage on the heart can be monitored regularly. Intervention performed at the right time when needed can reduce the risk of permanent damage to the heart muscle. In newborns with severe aortic valve stenosis in particular, early diagnosis and emergency treatment can be life-saving. Evaluation by pediatric cardiology and pediatric heart surgery specialists together helps determine the most suitable treatment method. Remember: Aortic valve diseases in children do not always require surgery. However, timely intervention is of great importance in serious stenosis or valve regurgitation. Determining the right method among options such as balloon dilation, valve repair, the Ross operation, and valve replacement helps protect children's heart health and quality of life.