Treatments for mitral valve stenosis in children

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Contact the Congenital Heart Valve Program

Boston Children's Hospital's cardiologists, cardiac surgeons and nurses, cardiac imaging professionals and other clinicians have a wealth of expertise in treating children with all types of heart defects and heart disease, with specialized understanding of problems like mitral valve stenosis that affect the valves of the heart. 

Our clinicians have extensive experience in treating every stage of mitral valve stenosis in children, adolescents and adults, as well as in utero. We use minimally invasive techniques—medical and surgical procedures that use small incisions and miniaturized cameras and tools—whenever we can, and are committed to repairing a child's own valve rather than resorting to an entire valve replacement whenever possible. Children's Interventional Catheterization Program has made great strides in allowing children to keep their own heart valves for as long as possible during treatment.

Your child's exact treatment plan will be determined by her age, the extent of narrowing in her mitral valve, her overall health and the preferences of you and your family.

Treatments for mitral valve stenosis

Monitoring
In the short term, children with mild to moderate mitral valve stenosis may not need any treatment other than routine monitoring, as long as they are displaying no outward symptoms and their daily lives are not affected by the condition.

Your child's cardiologist will regularly evaluate your child for any sign of further narrowing in the mitral valve and related complications. Most often, routine monitoring will involve physical examinations and echocardiograms

Medication
Medication is not a cure for mitral valve stenosis, but can be helpful in managing specific symptoms. In some cases, your child's clinician may prescribe medication to:

  • help the heart maintain healthy function and blood flow
  • control blood pressure
  • prevent abnormal heart rhythms, called arrhythmias

A child with mitral valve stenosis may also need to periodically take antibiotics in order to prevent an infection called Bacterial Endocarditis, even if his valve has been surgically replaced. Bacterial endocarditis can cause serious damage to the inner lining of the heart and its valves. You should always let medical personnel know about your child's mitral valve stenosis before making arrangements for a medical procedure, even if the procedure seems minor or unrelated to your child's cardiac care.

If your child has mitral valve stenosis, but no other cardiac problems, he probably will not need antibiotics before a routine dental procedure (for example, a teeth-cleaning).

Learn more about commonly prescribed medications.

Interventional catheterization/balloon valvuloplasty
Boston Children's has a program dedicated to interventional catheterization, the use of a thin tube called a catheter that is threaded from a vein or artery into the heart. We consider interventional catheterization the preferred way to treat children with mitral valve stenosis.

The most common interventional catheterization procedure used to treat mitral valve stenosis is balloon dilation or balloon valvuloplasty. With the child under general anesthesia, a small, flexible catheter is inserted into a blood vessel, most often in the groin. Using tiny, highly precise cameras and tools, clinicians guide the catheter up into the inside of the heart and across the mitral valve. A deflated balloon at the tip of the catheter is inflated once the tube is in place, and this balloon stretches the mitral valve open, reversing the problematic narrowing.

Watch a balloon valvuloplasty at Boston Children's. 

Valve replacement surgery
For children with severe mitral valve stenosis, balloon valvuloplasty may not adequately fix the narrowed valve. In other cases, as a child grows, an mitral valve that was previously treated successfully with one or more balloon dilation procedures begins to narrow again, adding strain to the heart and affecting blood flow throughout the body. Replacement of the mitral valve is the next step in treatment for these children.

During this procedure, cardiac surgeons will remove the damaged mitral valve and replace it with either:

  • a mechanical valve, made of ceramic or other synthetic materials

or

  • a donor valve taken from a human or animal donor (sometimes, new valves can even be fashioned from the child's own tissue)

Both types of valve replacement surgery have an excellent success rate and a low incidence of complications. Children who have either type of valve replacement procedure are likely to enjoy normal, healthy lives with minimal to no restrictions on playing sports or engaging in other strenuous activities.

After valve replacement surgery
Most children will need to stay in the hospital for a week to 10 days after valve replacement surgery, and will need another three to six weeks of rest at home before returning to normal daily activities.

Children with implanted valves—like children with mitral valve stenosis—are more susceptible to bacteria entering the bloodstream. The bacteria can cause a serious infection called bacterial endocarditis.  As a result, your child may need antibiotics before undergoing a routine medical procedure. If your child has undergone valve replacement surgery, you should always inform all medical personnel prior to any procedure.

It is likely that your child will need another valve replacement surgery within 20 years as the implanted valve ages.

How Boston Children's used an experimental valve to treat a 4-year-old boy with a life-threatening heart defect 

Read the story of this innovative treatment. 


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- Sandra L. Fenwick, President and CEO

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