Heart Valve Disease in Children

The human heart has four heart valves: atrial, mitral, pulmonary, and tricuspid. These valves have flaps that open and close so blood flows forward through the heart’s chambers.

Types of heart valve conditions

• Valve regurgitation occurs when blood leaks backward because a valve does not fully close.
• Valve stenosis occurs when valve openings narrow and block blood flow.
• Valve atresia is when valves do not fully develop in the womb and cannot open and close properly.

Pediatric heart valve conditions can be congenital, meaning they are present at birth, or acquired, meaning they develop after birth. Acquired heart valve diseases are often caused by an infection, like endocarditis (inflammation of the heart lining due to infection) or rheumatic heart disease (a complication of strep throat).

During your child’s appointment, a pediatric cardiologist will ask questions about your child’s symptoms, discuss your medical and family history, and perform a thorough physical exam. They may also recommend these tests:

Cardiac Imaging Scans
These can include a chest X-ray, echocardiogram, electrocardiogram (ECG), cardiac MRI, CT scan, and others.

Cardiac Exercise Testing (Cardiac Stress Test)
This test monitors your child’s vitals and heart function during exercise (for example, running on a treadmill).

Cardiac Catheterization 
During this minimally invasive diagnostic procedure, a small and flexible tube called a catheter is inserted into one of your child’s blood vessels (usually in the groin, but sometimes in the arm or neck). The catheter is guided to the heart while a camera displays your child’s anatomy on a screen in the procedure room. To diagnose your child’s condition, small tools can be passed through the catheter, or dyes can be injected into your child’s bloodstream to highlight abnormalities on imaging scans.

Duke pediatric heart specialists will consider your child’s unique anatomy, type of valve disease and severity, age, and other factors when recommending a treatment plan.

Observation
Some children with mild heart valve disease may not need immediate treatment. Instead, your child will attend routine follow-up visits to monitor their health and quickly identify any disease progression.

Medications
Medicines can help your child’s heart pump more efficiently and/or control symptoms.

Catheterization Procedures
Your child may be eligible for a minimally invasive catheterization procedure to repair or replace their heart valve. Compared to traditional surgery, catheterization procedures significantly reduce pain and shorten recovery.

Pediatric interventional cardiologists perform catheterization procedures in sterile rooms called catheterization labs. First, just like a diagnostic cardiac catheterization, a thin tube is inserted into one of your child’s major blood vessels and threaded to the problematic heart valve.

• During a valvuloplasty (also called a balloon valvuloplasty), which treats valve stenosis, a small balloon on the tip of the catheter is inflated to widen the valve opening and improve blood flow. 
   
• During transcatheter valve replacement -- including transcatheter pulmonary valve replacement (TPVR) and transcatheter aortic valve replacement (TAVR) -- a mechanical valve is placed inside the faulty heart valve and takes over its function.

Heart Valve Surgery
To give your child the best possible outcome, Duke pediatric heart surgeons offer the full range of surgical options to treat valve disease. 

• Valve repair surgery can reshape or strengthen a faulty heart valve.
   
• Mechanical valve replacement surgery places a new artificial valve inside the faulty heart valve to take over its function.
   
• The Ross procedure uses your child’s own pulmonary valve to replace their dysfunctional aortic valve. Then surgeons place a donor valve from a cadaver in the pulmonary valve’s original position. This maximizes both valves’ long-term efficiency.
   
• A partial heart transplant is an innovative surgery pioneered at Duke. Doctors replace the faulty valve in your child’s heart with a healthy valve from a heart that was removed during another child’s heart transplant. This allows the transplanted valve tissue to grow along with your child, so they may not need follow-up operations.

Less-Invasive Surgical Options
Traditionally, heart valve surgery requires a full sternotomy -- a large chest incision and separation of the breastbone. However, your child may be a candidate for one of several less-invasive approaches, which offer benefits like a faster recovery, less scarring, and fewer movement/lifting restrictions.

• Duke is one of the only centers in the region routinely using robotic technology, which allows for smaller incisions in less-visible places, like under the arm.
• Duke surgeons pioneered a technique that accesses the heart through an incision between the ribs.
• A lower partial sternotomy requires dividing only the lower part of the breastbone rather than the entire breastbone.

At Duke, a pediatric congenital heart disease surgeon and a minimally invasive heart surgeon work together for these types of operations. This means your child benefits from the unique expertise of two specialized surgeons.

Nationally Ranked Pediatric and Congenital Heart Center
As a Duke patient, your child benefits from the broad expertise and comprehensive resources of the Duke Pediatric and Congenital Heart Center, which consistently ranks as one of the nation’s top pediatric heart centers. Our team includes pediatric cardiologists, interventional cardiologists, and heart surgeons, as well as providers who specialize in pediatric intensive care, anesthesiology, cardiac perfusion, pharmacy, nutrition, physical and occupational therapy, and more.

Surgical Expertise, Proven Outcomes
Research shows that surgeons who perform more surgeries tend to have better outcomes. Duke pediatric heart specialists routinely see patients with rare and complex conditions. We have some of the best outcomes in the nation for pediatric heart surgery, according to the Society for Thoracic Surgeons and U.S. News & World Report.

Your Child Benefits from Breakthrough Research 
Our doctors are also scientists who are researching new ways to understand and treat heart valve disease in children. Your child may be eligible to participate in clinical trials that could give them access to advanced treatments.