Pediatric Heart Expert Forum
Are there any advanced Catheterization Procedures?
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Are there any advanced Catheterization Procedures?

My son has aortic stenosis and aortic regurgitation.  We are currently discussing the balloon catheterization procedure.  My son has a tricuspid valve but two of the leaflets are fused together.  It is my understanding that the best thing that could happen is the balloon would tear where it is fused together because there would be less regurgitation after.  However, there is no way to control where it tears.  Are there any advanced cath procedures where you can control the tear?
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Dear Matteos_Mom: Balloon valvuloplasty procedures for aortic stenosis are commonly performed by pediatric interventional catheterization specialists.  At cardiac catheterization, they measure the amount of blockage (stenosis) across the valve at rest, and also determine how much leakage is present by taking an angiogram (picture using contrast material).  It is only then that the doctor makes a final decision as to whether an intervention will be performed.  You have been appropriately informed that there is no way to control where a valve will be opened when a balloon valvuloplasty is performed. The doctors measure the size of the aortic valve ring (annulus) and use that information in choosing the size of balloon catheter to use, in order to minimize the risk of tearing the valve excessively.   There are no other techniques that currently exist that can impact on that, and so, the risk for a significant amount of valve leakage still accompanies these interventional procedures.  It is important to note that you do not state how much valve leakage is currently present in your son’s valve. If it is already significant prior to an intervention, then a balloon procedure would not be indicated.

Open heart surgery with either surgical valvuloplasty or valve replacement are other alternative treatments that currently exist for our pediatric patients with combined aortic stenosis and regurgitation of a significant degree.
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Dear Dr. Gleason,

Thank you for your advice.  Everything you wrote coincides with the information my son's doctor gave us.  I appreciate being able to get a quick second opinion like this.  I have three kids, aged 3 & under and it's not easy to go to the doctor's office!

Sincerely,
Matteo's Mom
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Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
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