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James is a 3 year old male, he has been referred to a cardiologist following history of breathlessness on exercise and a heart murmur. He has been diagnosed with aortic stenosis.

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The basic structure of the heart consists of:

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The heart functions in 3 circuits:

1. Systemic circuit - Concerning a loop of blood flow from the heart to the rest of the body
2. Pulmonary circuit - Concerning a loop of blood flow between the heart and lungs
3. Coronary circuit - Regarding the blood vessels which supply the heart with oxygenated blood and remove deoxygenated blood from the heart

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It is a narrowing of the aortic valve opening that leads to obstruction of blood flow from left ventricle to aorta.

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Caused by degenerative calcification changes in aortic valve.

Damage in endothelial cells due to increase mechanical stress.

Left ventricle systolic pressure increase.

Pressure overload in left ventricle leads to concentric ventricular hypertrophy.

Diastolic dysfunction of left ventricle.

Left atrium enlargement leads to left atrium hypertrophy.

Atrial fibrillation occurs

In later stage, aortic pressure decrease due to dilation of left ventricle and systolic dysfunction.

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The heart with stenoic valve cannot pump blood efficently. Due to stenosis, there is decrease of blood flow even when aortic valve is open. The following symptoms will be present because of decrease in cardiac output.

Dizziness

Fatigue

Shortness of breathe

Chest pain

Heart failure

Heart murmur

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Paediatric cardiologist and cardio thoracic surgeon will perform procedure depending on child symptoms, age and general health.

Balloon aortic Valvuloplasty: Done with catherisation where a catheter with a deflated ballon on top is inserted into blood vessel then move to the narrow aortic valve and balloon is inflated to help open the valve.

Aortic replacement: Replace the aortic valve with new valve which can be artificial or donor organ.

Surgical aortic Valvotomy: Removing scar tissue from the aortic valve leaflets which lets the leaflets to open.

Pulmonary autograph: Replace aortic valve and parts of aorta. Child’s own pulmonary valve and part of pulmonary artery used to replace the damage aortic valve.

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James is at the preoperational stage of Piaget’s developmental theory. The following are holistic impacts that aortic stenosis have on James:

Physical: He will become less active in activities. The Condition is incurable therefore it will make long term impact on his physical development. Having feeding difficulties is symptomatic of aortic stenosis and this can cause weight loss.

Intellectual: He will miss his school due to his illness therefore affects on the gaining skills and knowledge appropriate for his age.

Additionally, fatigue is symptomatic of aortic stenosis, therefore fatigue will impact James’s concentration if he has begun attending school, which may cause his development to be delayed compared to his peers, he will also miss out on participating in activities with his peers.

Emotional: James may become fearful about clinical environments if he has been repeatedly admitted to the hospital, or if he has recently undergone surgery. Consequently, he may develop anxiety in his later stages of development.

Furthermore, James may become isolated from his friends due to his inability to fully participate in all activities because of his breathlessness. Later on in life, this may lead to loneliness and depression.

Social: James’s ability to interact with other children will not be impacted however, due to his breathlessness and fatigue, he may not be able to fully participate in activities and sports with other children without stopping to take breaks from the activities.