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The Cardiovascular Program has established the Congenital Heart Valve Center (CHVC), which draws on our understanding of the biology of congenital heart valve disease, recent advances in diagnostic imaging, catheterization, surgical interventions and novel devices.
The CHVC cares for patients with the most common to the most complex forms of heart valve disease. The limitations in the size of bioprosthetic mechanical valves and degeneration over time, along with normal somatic growth, led us to establish a program aimed at developing novel solutions to the problems of young children and adults with valvular heart defects. The CHVC creates a broad framework to advance our knowledge and management of all forms of heart valve disease, and thereby improves the longer-term quality of life for our patients.
- foster collaboration among researchers, engineers, cardiologists and surgeons to translate knowledge into new therapies
- improve imaging modalities for precise anatomic and functional assessment of valves. This includes using real-time 3-D ECHO, cardiac MRI imaging and intracardiac echocardiography
- continue developing innovative surgical- and catheterization-based approaches to valve repair and reconstruction, and evaluate their safety and effectiveness
- use innovative approaches to improve the function of heart valves previously considered untreatable
- development of novel devices, such as tissue-engineered valves, steerable catheters for device delivery, and micro-electro-mechanical systems (MEMS) devices for valve reconstruction
- evaluation of new devices, such as absorbable polymer devices and stent-mounted percutaneous valves
- utilizing advanced image processing to better understand and treat diseased valves and guide minimally invasive procedures
- using computer-based simulations of patient-specific valve function to help plan for valve surgery
Aortic valve: We perform fetal interventions for hypoplastic left heart syndrome (HLHS) with aortic stenosis and/or intact atrial septums. If a neonate is born with critical aortic stenosis, we use catheter-based balloon dilation to dilate the aortic valve. As they grow into childhood, surgeons can repair complex aortic valve regurgitation and stenosis. As they mature into adulthood, surgeons can use aortic valve sparing techniques to repair the aortic root and/or complications from rheumatic heart disease.
Mitral valve: Mitral valve disease presents in a variety of ways. Some of these lesions are identified in the fetal and/or neonatal period (including mitral stenosis or atresia associated with HLHS), while others are identified in infants or children (double orifice mitral valve, cleft mitral valve, supra-mitral ring and rheumatic heart disease).
Tricuspid valve: Ebstein's anomaly is often diagnosed in the fetal period. Ebstein's anomaly of the tricuspid valve is a rare defect that often requires surgical reconstruction. New techniques such as the "cone" repair halve substantially improved the outlook for these patients. There are other forms of non-Ebstein's associated tricuspid valve disease (stenosis and/or regurgitation) that are also amenable to surgical repair.
Pulmonary valve: Pulmonary valve disease in the newborn often presents as pulmonary stenosis, which can be treated by our cardiologists in the catheterization lab. We have undertaken research and clinical trials to minimize the number of operations children need over their lifetimes with diseases such as Tetralogy of Fallot. We have significant experience with catheterization-based techniques to deliver trans-catheter valves into the pulmonary position. Many of these patients also benefit from imaging modalities and protocols developed at Children's that provide useful information about optimal timing for intervention on the pulmonary valve.
Atrioventricular (AV) valve disease: Patients with complex AV canal defects have often had prior surgery and have residual mitral stenosis and or insufficiency that needs surgical intervention. Single-ventricle patients with HLHS, unbalanced AV canal defects or heterotaxy syndrome often have a single or common AV valve. These valves often have incomplete co-aptation that results in systemic AV valve regurgitation. Most of these are now repairable.
Christopher W. Baird, MD
Director, Congenital Heart Valve Center
Pedro J. del Nido, MD
Chairman, Cardiac Surgery
Sitaram Emani, MD
Assistant, Cardiac Surgery
Tal Geva, MD
Chief, Non-Invasive Cardiac Imaging
Gerald R. Marx, MD
Cardiologist
Doff B. McElhinney, MD
Associate in Cardiology
Schedule appointment or consult: 617-355-5637
More information: childrenshospital.org/heartvalves
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