Does your child really need a Valve Replacement? Here's what parents should ask

The heart has four valves — mitral, aortic, tricuspid, and pulmonary. The mitral and aortic valves are on the left side of the heart, while the tricuspid and pulmonary valves are on the right side.

As paediatric cardiac surgeons, we deal with small children, sometimes even babies, who have a leaking valve, a narrowed valve, or a valve with a combination of both, along with other defects in the heart such as “holes.” These situations become challenging, as replacing the valve is technically an easier surgery. There are broadly two types of replacement valves — mechanical and bioprosthetic.

If a mechanical valve is inserted, complications persist lifelong for the child. They will have to be on strong blood thinners. If too much is taken, the child can have bleeding tendencies; if too little, clots can form on the valve, leading to disastrous consequences. Bioprosthetic valves (from buffalo or pig) are not ideal, as they do not last long and will require further open-heart surgeries.

A more technically challenging surgery is valve repair. This requires greater skill, ingenuity, imagination, and experience to perform successfully. By doing this, the child can avoid valve replacement in childhood, and even gaining 10–15 more years of function from the patient’s own valve would be ideal. When the child grows into an adult, they can then have a larger, adult-sized valve implanted if needed.

Mitral and aortic valve defects can be congenital — meaning the baby is born with them — or, in our country, they can be damaged by rheumatic fever. Based on the disease process and various anatomical and pathological factors, an experienced surgeon uses one or more techniques to restore the valve to a functional, anatomically competent state.

In the case of the tricuspid valve, Ebstein anomaly is a congenital condition for which we perform a complex surgery called Cone repair, aiming to make the valve as close to normal as possible.

There are other valve-related issues associated with complex conditions such as common atrioventricular canal defects and partial AV canal defects, where abnormal valves are associated with one or more holes in the heart. The valve defect may also be part of a syndrome such as Shone’s complex.

To summarise:

1. Valve problems are not uncommon in children, even in infants.
2. Valve replacement should be avoided, if possible, in younger age groups, as one disease process may be replaced with another.
3. Always assess whether the child can wait for surgery. Timing is key. Waiting too long may result in the valve becoming too damaged for repair or the heart too damaged to recover. However, waiting may be worthwhile when the valve is not severely affected, the heart function is stable, and the child is too small.
4. It is best to perform valve surgeries in centres experienced in paediatric valve repairs.
5. Strict follow-up after surgery is essential, including disciplined adherence to medical advice, treatment protocols, and follow-up schedules.
6. The aim of the multidisciplinary treatment team should be to ensure a normal lifespan for the child, with excellent quality of life and minimal complications or side effects.
7. The key lies in the surgical team having the mindset, patience, and expertise to preserve the child’s own valve.

Featuring insights from Dr. Neville Solomon, Senior Consultant, Paediatric & Adult Congenital Cardiac Surgeon, Apollo Children's Hospitals, Chennai

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