My 6 year old son starting seeing a pediatric cardiologist when he was 3 for a heart murmur at which time we were told he has a bicuspid aoritc valve insufficiency. His heart was on the upper side of normal and had minimal to moderate leakage. He has been seeing his cardiologist each year for the last 3 years and up until his last appointment 2 weeks ago he had remained stable with no changes, he has also been asymptomatic. When we went for our appointment 2 weeks ago his the leakage had increased to moderate and his heart size had gone past normal for his size and age (she said he should be at 42 and it was at 45). His cardiologist sent his echo to the board of surgeons who thought it would be best to do a repair of this valve but then decided to put him on enalapril for 6 month and then do another echo to see if the enalapril is helping. Is it likely that these changes will continue to increase or will the enalapril keep his heart functioning well enough that he will not need surgery? Also he wants to do wrestling in a month or so (not much contact as it is for kindergarden - 2nd grade kids) is this something he should be limited in?
The natural history of bicuspid aortic valves is variable during childhood. Aortic valve leakage can be progressive even at young ages. It is appropriate to start after-load reducing medication (like enalapril) when the left ventricular size increases above normal. This medication tries to make it "easier" for the blood to move forward, instead of backward, across the aortic valve. It does not directly affect the valve (no medication can) but if the left ventricular size stabilizes, then surgery may be able to be deferred for a while. Sometimes surgeons can perform a "plasty" procedure on the native aortic valve, to tighten it up, and decrease the leakage. It may not be perfect, but many times a valve replacement can be avoided for some period of time. Since aortic valve replacement is always a possibility, it is preferrable (when safe to do so) to hold off on surgery until a patient is physically larger, as the options for valve replacement are less optimal and have need for on-going replacement, in younger children as they grow. Do not expect any drastic changes in the echo in 6 months time. Your doctor will be follwing the size and function of the left ventricle as your child grows. Finally, isometric sports, like weight lifting, wrestling and football are NOT to be encouraged in this situation, as it can worsen valve leakage.
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