In the past, children and adults with congenital pulmonary valve defects or valve damage that occurred over time had only one option – open heart surgery to repair or replace the valve.
Today, minimally invasive transcatheter pulmonary valve (TPV) therapy is available to treat narrowed or leaking pulmonary valves, allowing many patients to avoid the risk of complications and longer recovery time associated with open heart surgery.
At Children’s Memorial Hermann Hospital, affiliated pediatric cardiologists use a holistic approach to treatment in a child-friendly environment, with the goal of improving heart function. They also continue to care for the heart needs of adult patients and provide transcatheter pulmonary valve therapy when needed, at any stage of life.
Most patients who undergo pulmonary valve therapy return home the day after the procedure and can return to school, work and routine activity immediately, without pain and the need for prescription medication.
While pulmonary valve therapy is not designed to replace open heart surgery, it will delay the need for it and reduces the number of procedures people with pulmonary valve conditions have to undergo in their lifetime.
The pulmonary valve is an opening on the right side of the heart that regulates blood flow from the right pumping chamber of the heart to the lungs. Several conditions that affect the functioning of the pulmonary valve can occur before birth, including pulmonary atresia, Tetralogy of Fallot and double outlet right ventricle. These congenital heart defects change the way blood flows through the heart.
Pulmonary atresia is a form of congenital heart disease in which the pulmonary valve does not form properly before birth. A solid layer of tissue forms where the valve opening should be, causing the valve to remain closed. As a result of this defect, blood from the right side of the heart cannot travel to the lungs to receive oxygen. Symptoms usually occur in the first few hours or days of life: bluish-colored skin (cyanosis), rapid breathing, fatigue, tiredness during nursing and shortness of breath.
Tetralogy of Fallot is a congenital heart condition with four components: a hole between the right and left pumping chambers of the heart (ventricular septal defect); a pulmonary valve that is too narrow; a thicker-than-normal pumping chamber on the right side of the heart (right ventricular hypertrophy); and the connection of the aorta closer to the right side of the heart than normal.
Double outlet right ventricle is a birth defect in which the aorta connects to the right ventricle – the chamber of the heart that pumps blood to the lungs – instead of the left ventricle – the chamber that normally pumps blood to the body.
These heart conditions are frequently treated by surgical repair or implantation of a valved conduit to replace the malformed pulmonary valve. Over time these conduits malfunction, leading to pulmonary valve conduit failure. In the past, open heart surgery was necessary to replace them. Now pediatric cardiologists can treat the malfunction by placing a transcatheter pulmonary valve in a minimally invasive procedure.
Pulmonary valve conduit failure can be caused by a narrowing (stenosis) that limits blood flow from the heart to the lungs, causing the heart to work harder to pump blood to the lungs, or leakage (regurgitation) in which blood is allowed to flow backward into the right pumping chamber of the heart.
A catheter that houses a specially designed heart valve is inserted into the femoral vein in the leg and threaded to the heart. The Melody® valve is made from a cow’s jugular vein attached to a wire frame (stent). When the valve wears out it can be replaced with a new one. The Melody® valve is used for patients with smaller pulmonary valves and conduits, usually children, teenagers and young adults.
The SAPIEN XT® consists of a catheter-based artificial valve made of cow tissue attached to an expandable frame for support. After insertion through the femoral vein in the leg, it is guided through the blood vessels until it reaches the damaged pulmonary valve, where it is positioned to function as a normal valve. The SAPIEN XT® is used for patients with larger pulmonary arteries, usually larger adults or patients with more dilated pulmonary valves or conduits.
At Children’s Heart Institute at Children’s Memorial Hermann Hospital, patients with congenital or acquired heart disorders receive hands-on specialized care 24/7 from a team of affiliated physicians and specialty-trained nurses who aim to deliver the best possible outcomes.
Children’s Memorial Hermann Hospital was named one of the top 50 best children's hospitals nationally in Cardiology & Heart Surgery by U.S. News & World Report. In addition, Children’s Heart Institute is among the top congenital heart surgery programs in North America for patient care and outcomes, according to the Fall 2019 Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database Report of 118 STS participating programs.
In collaboration with various subspecialties, the affiliated team provides comprehensive care for newborns, children and adolescents, with the ability to transition into adult congenital cardiac care. Team members have the experience and skills necessary to offer innovative treatment methods and specialized services, including, but not limited to:
With the Level IV Neonatal Intensive Care Unit (NICU) and a dedicated Children’s Heart Institute Intensive Care Unit at Children’s Memorial Hermann Hospital, critical heart patients have access to quality, specialized care. By utilizing state-of-the-art techniques, the team at Children’s Heart Institute strives to offer patients with the most complex problems the greatest opportunity for a normal life.
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