Pediatric Subvalvar Aortic Stenosis Guidelines

Updated: Jan 29, 2021
  • Author: Douglas J Schneider, MD; Chief Editor: Howard S Weber, MD, FSCAI  more...
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Guidelines Summary

Aortic valvuloplasty

In 2011, the American Heart Association (AHA) released guidelines for interventions in pediatric cardiac disease that included the following class I recommended indications for aortic valvuloplasty in children [24] :

  • In newborns with isolated critical valvar aortic stenosis (AS) who are ductal dependent regardless of valve gradient
  • In children with isolated valvar AS who have the following characteristics:
    • Depressed left ventricular systolic function
    • ​Resting peak systolic valve gradient (by catheter) of ≥50 mm Hg
    • Resting peak systolic valve gradient (by catheter) of ≥40 mm Hg in the presence of anginal or syncopal symptoms or ischemic ST-T-wave changes on electrocardiography at rest or with exercise

According to these guidelines, aortic valvuloplasty may be considered in an asymptomatic child or adolescent with a resting peak systolic valve gradient (by catheter) of ≥40 mm Hg or without ST–T-wave changes if pregnancy or participation in strenuous competitive sports is desired (class IIb).

Aortic valve balloon dilation is not indicated in children with isolated valvar AS who also have a degree of aortic regurgitation that warrants surgical aortic valve replacement or repair (class III).

Infective endocarditis prophylaxis

The 2011 AHA guidelines defined the following patient groups as at highest risk for adverse outcomes from IE [24] :

  • Those with prosthetic cardiac valves or prosthetic material used for cardiac valve repair
  • Those with previous IE
  • Those with unrepaired cyanotic congenital heart disease (CHD), including palliative shunts and conduits
  • Those with CHD and completely repaired congenital heart defect that was repaired with prosthetic material or device, regardless of placement by surgery or catheter intervention, during the first 6 months after the procedure
  • Those with repaired CHD who have residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device
  • Recipients of cardiac transplantation who develop cardiac valvulopathy

In a 2015 scientific statement updating its recommendations on IE in childhood, the AHA advocated for a shift in focus from antibiotic prophylaxis to an emphasis on oral hygiene and prevention of oral disease. However, the AHA recommends considering prophylactic antibiotic drugs before certain dental procedures for children in the highest-risk groups (class IIb), such as those discussed above. [25]