Aortic Valve Disease | Diagnosis & Treatments
How we approach treatment for aortic valve disease
The Congenital Heart Valve Program at Boston Children’s specializes in the care and treatment of aortic valve disease.
Our team carefully considers two primary approaches before treating aortic valve disease: aortic valve repair and aortic valve replacement. Our approach depends on the individual case, taking into account a patient’s condition, the severity of the disease, their heart anatomy, and overall health. Using innovative three-dimensional modeling — as well as two- and three-dimensional cardiac echocardiography, CT scans, and cardiac magnetic resonance imaging (MRI) — we can see all aspects of a patient’s aortic valve disease and their heart anatomy, allowing us to determine the right approach for treatment and how we can best preserve the native tissue.
Making the Ross procedure a safe aortic valve replacement option
Learn how the Ross procedure gives children a long-lasting aortic valve replacement.
Thanks to advancements in cardiac imaging, we can evaluate the characteristics of a fetus’ heart anatomy. We work closely with the Fetal Cardiology Program to detect and diagnose aortic valve disease and any CHD in the fetal stage. We can potentially intervene before birth with specialized in utero treatment, including procedures such as fetal cardiac intervention and fetal therapy treatments with medications. Working with our colleagues in the Neonatal Cardiac Surgery Program, we also treat newborns for valve conditions such as aortic valve stenosis.
Aortic valve repair or reconstruction
We believe children benefit when their heart valves can be repaired, rather than replaced. We focus on developing solutions and techniques to repair aortic valves so they can remain structurally intact and keep the other parts of the heart strong and healthy. That includes new reconstruction techniques that can improve the function of diseased aortic valves that were once considered untreatable. Here are four types of repair and reconstruction procedures we perform:
- Simple leaflet repair: This procedure focuses on restoring an existing damaged leaflet of the aortic valve by thinning or implanting it again.
- Complex leaflet repairs/bicuspidization: This type of procedure involves more intricate modifications of the valve leaflets and their relation to the aortic root and neighboring aorta. The bicuspidization technique creates two symmetric leaflets.
- Valve-sparing aortic root repair: This surgical technique preserves the native aortic valve and replaces the aortic root.
- Ozaki procedure: The Ozaki procedure, or neocuspidization, is a complex aortic valve treatment that reconstructs degenerated leaflets. We create customized leaflets from a patient’s own tissue (pericardium).
Aortic valve replacement
Unfortunately, some children have advanced tricuspid valve disease and repairs aren’t enough. They instead need a replacement valve. This approach involves removing the damaged aortic valve and replacing it with a mechanical or biological valve — or in certain cases, we replace it with a patient’s own pulmonary valve. Mechanical replacement valves are durable but have drawbacks (see below). Also, small prosthetic valves are limited in availability, which means young patients may need more interventions as they grow. We are always trying to extend the life of a replacement aortic valve and avoid the disadvantages of bioprosthetic and mechanical replacement options. Here are four types of aortic valve replacement procedures we perform:
- Bioprosthetic aortic valve replacement: Bioprosthetic tissue that replaces an aortic valve is made from animal tissue (pig or cow). A drawback is the animal tissue might not last long and a patient will eventually need another replacement valve.
- Aortic homografts/allograft aortic valve replacement: These are tissue valves from a human donor. It is commonly used to treat endocarditis (when bacteria infects the heart valve). The benefit is a patient won’t need blood thinners throughout a lifetime, but, similar to bioprosthetic valves, these wear out and eventually need to be replaced.
- Mechanical aortic valve replacement: Mechanical aortic valves are made of strong, durable materials like metal or carbon. They don’t wear out easily and can last a long time. However, the risk of blood clot formation is high, so a patient will have to take blood thinners over a lifetime.
- Ross procedure: We move the patient’s own pulmonary valve (the valve that controls blood flow from the heart to the lungs) into the place of the damaged aortic valve, which is removed. We then place a donor valve, or conduit, where the pulmonary valve used to be. The advantage of the procedure is that it does not require a patient to take anticoagulation medications throughout their lifetime. A disadvantage is the donated pulmonary valve will probably have to be replaced once or a few times over a lifetime.
- Partial heart transplant: In 2024, our heart specialists started offering another aortic valve replacement option: transplanting a donor’s healthy valve into a patient’s heart. Because it is human tissue, the donated valve should require a lesser amount of immunosuppressives for several months after the procedure. But just as importantly, the valve should grow along with the patient’s heart anatomy.
Eight years of preparation for a surgical first: a partial heart transplant
Our cardiac surgeons performed a partial heart transplant on 4-year-old Jack. It’s possibly the first such transplant as an elective procedure, and probably the first of many at Boston Children’s.
