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Pediatric Pulmonary Valve Replacement

For patients with pulmonary valve regurgitation, a pulmonary valve replacement may be recommended.

What Is Pulmonary Valve Regurgitation?

Pulmonary valve regurgitation occurs when blood leaks backwards into the right ventricle after being pumped forward into the pulmonary artery. Sometimes pulmonary regurgitation is referred to as pulmonary valve incompetence. Patients with pulmonary valve regurgitation are frequently asymptomatic, and therefore benefit from advanced imaging techniques, such as cardiac MRI, allowing precise measurements of the right ventricle to be taken. At Lurie Children's, these studies are performed by a team of dedicated, highly skilled cardiac radiologists.

Most commonly this is associated with Tetralogy of Fallot post-surgical repair.

However, severe pulmonary regurgitation over many years leads to right ventricular enlargement and ultimately right ventricle dysfunction, at which time replacement of the pulmonary valve is usually recommended. Since patients with pulmonary valve regurgitation are frequently asymptomatic, the goal is to place a competent valve before the right ventricle is permanently damaged. Therefore, regular check-ups with a pediatric cardiologist are important.


When Is Pulmonary Valve Replacement Typically Performed?

The exact timing of when to place a new pulmonary valve is controversial, but over the last 25 years more information has been gathered about the harmful effects of long-standing pulmonary regurgitation, therefore the threshold for proceeding with valve placement has changed. For those patients with symptoms a new valve is indicated.

How Is Pulmonary Valve Replacement Performed?

When replacement of the pulmonary valve is recommended, it can be achieved two ways: surgery and catheterization. Lurie Children’s has experts in both areas so all patients can be managed successfully.    

Pulmonary valve replacement is a standard procedure and the most common surgery in adults with congenital heart disease. Surgical placement of a bio-prosthetic valve usually requires less than a week in the hospital to recover.

The location of the valve is commonly referred to as the “outflow tract”, and all sizes and shapes can be managed successfully via the surgical approach.

Newer, less invasive transcatheter approaches have been developed to place a new pulmonary valve. In the USA, there are two valves FDA-approved for trans-catheter pulmonary valve replacement in dysfunction conduits. The valves can also be placed off label in large native outflow tracts. As the chest does not need to be re-opened, the recovery time is much shorter and usually only requires an overnight observation. However, with only two types of valves available, sometimes the anatomy is not suitable for a catheter-based valve, and these patients require the surgical approach instead. 

Pulmonary Valve Replacement at Lurie Children's

Approximately 15 transcatheter pulmonary valve replacements are performed yearly at Lurie Children’s.

All patients are evaluated by a multi-disciplinary team of specialists with expertise in cardiology, imaging, surgical and transcatheter approaches to pulmonary valve replacement, allowing treatment tailored to each patient's unique anatomy and physiology.

By partnering with physicians at the Bluhm Cardiovascular Institute at Northwestern Medicine, our team of experts in congenital heart disease is also able to provide care to patients throughout their adult lives.

Our Specialists

Michael C. Mongé, MD

Surgical Director, Heart Failure/Heart Transplant Program; Attending Physician, Cardiovascular-Thoracic Surgery; Member, Lurie Children's Surgical Foundation

Assistant Professor of Surgery (Cardiac Surgery), Northwestern University Feinberg School of Medicine

Sunjay Kaushal, MD, PhD

Division Head, Cardiovascular-Thoracic Surgery; A.C. Buehler Professorship in Surgery; Member, Lurie Children's Surgical Foundation

Professor of Surgery, Northwestern University Feinberg School of Medicine

Osama M. Eltayeb, MD

Director, Vascular Rings Program; Attending Physician, Cardiovascular-thoracic Surgery; Member, Lurie Children's Surgical Foundation

Assistant Professor of Surgery (Cardiac Surgery), Northwestern University Feinberg School of Medicine

Alan W. Nugent, MD

Section Head, Interventional Cardiac Catheterization

Professor of Pediatrics, Northwestern University Feinberg School of Medicine

Paul Tannous, MD, PhD

Attending Physician, Cardiology

Assistant Professor of Pediatrics, Northwestern University Feinberg School of Medicine

Jeremy L. Fox, MD

Attending Physician, Cardiology

Assistant Professor of Pediatrics, Northwestern University Feinberg School of Medicine

Research

In addition to our current surgical and transcatheter approaches, physicians at Lurie Children’s are actively involved in clinical trials and researching newer technologies. The aim of our research is to minimize the number of procedures children and adults with pulmonary valve disease need over a lifetime and shorten the recovery from such procedures. Dr. Nugent holds a patent related to transcatheter pulmonary valve replacement.

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