Pediatric Heart Expert Forum
Pulmonary valve replacement
About This Forum:

Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Blank Blank

Pulmonary valve replacement

Can you tell me what the typical criteria is for replacing a pulmonary valve in a teenager(17yo) s/p TOF/APVS repair? Current valve/conduit is 13 yo, severe insufficiency(47%) but only mildly dilated/hypertrophied RV, RV end-diastolic upper limits of normal, recent DX of VT and currently taking Beta Blocker. Also, blood flow to RPA is 75% and LPA is 25%. Recommendation is watchful waiting.
773655_tn?1340656399
This is a question that does not have a definite answer, as most cardiologists are individualizing recommendations for a pulmonary valve replacement in Tetralogy of Fallot based on the particular patients issues. The degree of right ventricular enlargement is the most important factor, with RV volumes in excess of 170 ml/m2 felt to be at risk for long term RV dysfunction.  If serial MRIs show a drop in RV ejection fraction ( a measure of the heart's contractile function), then that is an indicator.  If the patient develops complex arrhythmias like ventriclar tachycardia, that is a factor.  If there is progressive exercise intolerance or a negative change in objective exercise testing, that is a factor.  In most situations the patient has to undergo an open heart surgery to replace the pulmonary valve, and then that valve will degenerate with time, usually within 10 years or so.  This will then need replacement.  At present there is not an FDA approved stent mounted device to put in native outflow tracts during a cardiac catheterization.  But if your child has a conduit (tube) between the right ventricle and the pulmonary artery, depending upon its size, they may be a candidate for a Melody valve (stent mounted bioprosthetic valve) that can be placed during a cardiac catheterization.  You would need to check with your child's cardiologist to see if that is the case.  Your child's new onset of ventricular tachycardia is of concern, and that should be an important factor regarding the timing of an intervention.
Blank
Continue discussion Blank
This Forum's Experts
773637_tn?1327450515
Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
Philadelphia, PA
Blank
Request an Appointment
MedHelp Health Answers
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
RSS Expert Activity
242532_tn?1269553979
Blank
Control Emotional Eating with this ...
Sep 04 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eating Control: How to St...
Aug 28 by Roger Gould, M.D.Blank
233488_tn?1310696703
Blank
New Cannabis Article from NORTH Mag...
Jul 20 by John C Hagan III, MD, FACS, FAAOBlank