Pediatric Heart Expert Forum
aortic stenosis
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aortic stenosis

I have an 11 year old who was born with critical aortic stenosis... at 4 months, after 1 previous surgery.. he ended up with a modified Ross_Konno... he does not have a pulmonary valve.. and a neo-aortic valve now...  we are checking him every 6 months.. waiting to see when the next surgery will happen...  what is the latest research on what the best valve to use would be??  is there any way of growing your own valve with stem cells yet???
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Critical aortic valve stenosis is a difficult medical condition because it usually does require several interventions during childhood.  When the native aortic valve is replaced by the person's own pulmonary valve (Ross procedure) and the left ventricular outflow tract is enlarged to relieve blockage (Konno procedure), then the patient needs to have a conduit of some type (usually a pulmonary artery homograft) placed between the right ventricle and the pulmonary artery (this takes the place of the native pulmonary valve that was moved).  Subsequent interventions are several: 1) the person outgrows the conduit and needs a larger one placed, 2) the neo-aortic valve "fails" and leaks excessively and needs to be replaced, 3) the neo-aortic root can dilate excessively leading to valve leakage and need for valve repair or replacement.   Currently there are no stem cell options available in the clinical realm.  The type of valve replacement that occurs is dictated by the age and size of the patient.  Younger patients need homograft valves because they come is small sizes.  Older children/teens can have either a bioprosthetic valve (pig or bovine valve) that does not require the use of an anticoagulant; but these usually only last up to 10 years.  Larger patients may choose a mechanical aortic valve replacement that lasts a long time (more than 20 years) but requires anticoagulation.  Since your child is 11 years old, it is likely that your doctors will try to put off intervention as long as it is safe, to get him as big as possible.  This will allow them to put in the largest valve or conduit that they can at the next surgery, and hopefully that would last for a longer time.  But in reality, he will likely need more surgery even as an adult, since the conduits between the right ventricle and the pulmonary artery will not last a lifetime.
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Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
Philadelphia, PA
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Marie M Gleason, M.D.Blank
The Children’s Hospital of Philadelphia
Philadelphia, PA
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