Heart Valve Repair and Replacement
What is heart valve repair and replacement in children?
When heart valves are absent or defective in children, the problem is dealt with in a variety of ways. It is often possible for a child's heart to perform well with one missing or defective right-sided valve. The left-sided valve function, however, is much more critical, and repair is more often necessary. Replacement with artificial valves is best avoided in children, because the artificial valve material cannot grow with the child and because blood thinners are necessary any time an artificial valve is used. When it is necessary to replace a valve in a child's heart, oftentimes we resort to the use of allograft materials (this is also known as homograft material).
These are human cadaver valves that have been donated and harvested shortly after death. The valves are sterilized and preserved in deep freeze until the time of their use. An appropriately sized valve is selected to accommodate the child's needs. The long-term effectiveness and durability of these valves is not perfect, but they are currently the best available surgical technology for children.
Often these valves are used with accompanying pieces of aorta or pulmonary artery that is preserved with the valve and are very useful for complex reconstruction of multiple heart defects. The placement of such a valve conduit between the right ventricle and the pulmonary artery is often referred to as the Rastelli Procedure. Allograft valves also do not grow with the child. When they are used, they will need to be replaced later in life as the child grows. Replacement of the aortic valve in children is usually carried out using the Ross Procedure.
Preparing for the procedure
Prior to cardiac surgery, this heart defect will be diagnosed with an EKG, a chest x-ray and an echocardiogram. Before surgery, blood tests are conducted to be sure that there is no infection and no problem with clotting, and that normal electrolyte levels are in the blood. A blood test to determine the blood type and compatibility will be performed so that blood will be available for the surgery.
During the procedure
During the procedure, the child will be placed under general anesthesia, and special monitoring intravenous lines will be put in. The chest is entered through the sternum (breastbone). The heart/lung machine is connected and, once the heart is stopped and empty, the heart valve will be visualized and the repair or replacement will take place. Once the procedure is finished, the heart is allowed to fill and start beating. The chest is then closed. The child stays on the breathing machine for a few hours (sometimes overnight). When the child is awake enough and the heart appears strong enough, the breathing machine is discontinued.
After the procedure
After surgery, the child will need a number of days to recover from anesthesia, from the use of heart-lung bypass equipment and from the surgery. Initially, the child will be on a ventilator (breathing machine) and may need support from intravenous medicines and a temporary pacemaker. Once the breathing tube (endotracheal tube) is out, the main goals are for the child to return to normal activity and begin eating normally and gaining weight.
Click here for recovery guidelines after discharge for congenital heart surgery repair at the Inova Heart Center.
- Atrial Septal Defect (ASD) Repair
- Ventricular Septal Defect
- Tetralogy of Fallot Repair
- Arterial Switch for TGA
- Atrioventricular Canal Surgery
- Bidirectional Glenn
- Fontan
- Heart Valve Repair and Replacement
- Ross Procedure for AVR
- Patent Ductus Arteniosus
- Coarctation of the Aorta Repair
- Systemic to Pulmonary Shunt
- Pediatric Recovery
