Normal ST segments and T waves changing into
ST elevation or depression with T wave changes is an indication that
aortic stenosis is severe.
Mild cases usually do not progress.
Moderate and severe cases usually do
Follow-up should be every year with
electrocardiography. A 24-hour Holter monitor should be performed once
every five years or more frequently if ectopy are encountered.
Exercise testing should be performed once
every two years and echocardiography once every two years.
Subacute bacterial endocarditis accounts for
0.3% of patients.
Sudden death may occur to any patient with
aortic stenosis but mainly symptomatic patients.
Competitive sports should be prohibited in
those with pressure gradients of 40 mm Hg or more.
Repeat surgical procedure is typically not
helpful. Repeat valvoplasty may be more helpful.
25% of patients with surgical repair develop
aortic valve regurgitation.
Infants With Aortic
These infants present early in life with
congestive heart failure and aortic stenosis murmur.
The more severe cases result in decreased
cardiac output presenting with an ashen color and decreased pulses.
The aortic valve leaflets are typically thick
and gelatinous with small aortic valve ring. The left ventricle may be
small and in some instances smaller than what could be compatible with
adequate cardiac output (20 ml in newborns).
Patent foramen ovale will allow left-to-right
shunting therefore decreasing the cardiac output.
PDA allows right-to-left shunting and
improves cardiac output.
Balloon valvoplasty is helpful and is less
risky than surgery but with risk of aortic insufficiency.
Surgical morbidity is acceptable.
Rarely, evolve to normal looking valves as
the child grows.
Usually residual aortic stenosis is left.