Valve Disease in Children
There are four important valves in the human heart; it is the job of each valve to assure that blood flows only forward (the correct way) and not backwards the wrong way. The names of these valves are aortic, mitral, pulmonary and tricuspid. Each is required to function properly in reorder to assure a normal, active and healthy life expectancy.
When one or more of the heart valves fail, some of the chambers of the heart become enlarged, and the patient will eventually have heart failure. Heart failure from valve disease can be quite progressive and severe and can ultimately lead to death. The exact timing of this progression depends on which valve is affected and how severe the valve function is deranged.
If your child has valve disease, it is very likely that surgery will be required at some point. However, the exact age and exact type of surgery is very variable depending on the valve, age and specific disease. Some valves can be repaired; this means that we can use the child’s native valve tissue to make the valve work. Repairs are sometimes successful for a while, but many repaired valves will eventually have to be replaced at a later surgery. Replacement means that the original valve is removed entirely and an artificial valve has to be surgically implanted in the heart.
When and if you or your child requires valve replacement, one major decision is what type of a valve. There are two major types of valves. One is so called mechanical, meaning that it’s made of carbon fiber and metal. The other is called biologic, meaning that it is some type of animal or human valve (not artificial). In general, mechanical valves last a lot longer but require a blood thinner called Coumadin. Taking Coumadin has serious implications; if your blood is thinned, your activity is restricted and you are at risk for bleeding. Biologic valves do not last as long. They wear out faster, depending on the age of these patients at the time of implant. But biologic valves have a big advantage in that they do not require long-term Coumadin or blood thinner, which means less restriction on you or your child’s activity.
The decision becomes even more complicated in small children because despite how long the valve may or may not last, a growing child will often outgrow an implanted valve even before it wears out. With all of these competing factors in the decision, it is very important for your pediatric heart surgeon to be familiar and experienced with each type of valve replacement and repair option under all the various circumstances.
Rady Children’s Hospital-San Diego has been offering valve repair and replacement surgery to children for more than 30 years. We have been trained in each option, and our senior partner has taught courses on the Ross procedure, one of these most difficult type of valve replacement options. Standard-risk patients now enjoy a >95 percent success for valve operations at experienced centers like our own.
Because valve repairs often do not last, patients outgrow replaced valves and because replaced valves wear out, it is common to have to have multiple surgeries for valve problems throughout a patient’s lifetime. Surgery becomes more complicated and higher risk as the patients require more repeat procedures. Many adults who have had valve work done as children will require reoperations.