Mayo Clinic's approach

Pulmonary valve disease consultation at Mayo Clinic

At Mayo Clinic, a multidisciplinary team works together to provide expert care to people with pulmonary valve disease.

Teamwork

At Mayo Clinic, a team of cardiovascular surgeons, cardiologists and other health care professionals work together to provide coordinated, comprehensive care for people who need pulmonary valve repair or pulmonary valve replacement. If you have other health concerns in addition to pulmonary valve disease, care providers can often evaluate and treat other conditions during your visit.

Advanced technology and treatment

Mayo Clinic is an established pioneer in the field of cardiovascular surgery, and our cardiovascular surgeons perform more than 4,500 cardiac surgeries each year.

People who come to Mayo Clinic for pulmonary valve disease treatment have access to state-of-the-art diagnostic and treatment facilities. Mayo Clinic health care providers routinely use the latest cardiac MRI and other imaging technologies to evaluate pulmonary valve disease and help determine the most appropriate treatment plan.

Cardiac MRI

A cardiac MRI provides still or moving pictures of how the blood flows through the heart and heart valves. It is often used to diagnose pulmonary valve disease.

Mayo Clinic cardiovascular surgeons and care providers offer the latest pulmonary valve disease treatment options, including minimally invasive options. Minimally invasive procedures, such as transcatheter and valve-in-valve pulmonary valve replacement, use smaller incisions and may involve a quicker recovery.

Mayo Clinic surgeons are experienced in complex pulmonary valve repair and replacement of deteriorating replacement valves using hybrid and customized procedures involving stents, patches and other techniques to prolong valve life.

Heart valve repair and replacement surgery at Mayo Clinic

Cardiac surgeons at Mayo Clinic are pioneers in the field and perform more than 4,500 procedures a year.

Valve problems in children with heart disease: What patients and families should know

Joseph A. Dearani, M.D., a cardiovascular surgeon at Mayo Clinic, discusses common issues in treating children with heart valve problems, including the timing of medical intervention and treatment options.

My name is Dr. Joseph Dearani, and I am the Chair of Cardiovascular Surgery at the Mayo Clinic, with an area of expertise in pediatric and congenital heart disease. So today, I'd like to talk about valve problems in children with heart disease. What would be important for patients and families to know? We'll focus on the leaky valve, or the regurgitate valve, as the physicians call it. Mitral, tricuspid, and aortic valves are the classic valves that could have a leaky problem that would require treatment. Any of them could consist of a variety of diagnoses that range from an actual structural abnormality of the valve, such as Ebstein's anomaly of the tricuspid valve, or congenital, mitral, or tricuspid regurgitation, mitral or tricuspid valves, as they relate to the atrial ventricular septal defect or atrial ventricular canal defect.

Pulmonary atresia with intact ventricular septum can have tricuspid valve problems. And there can also be the bicuspid aortic valve which an individual may be born with. And that value may be vulnerable to narrowing or leakage. Finally, there actually can be iatrogenic injury of a valve during the repair of another lesion. For example, injury to the tricuspid valve during the course of closure of a ventricular septal defect.

There can be valve problems related to dilation of the annulus, which may be a secondary problem to an abnormality with the ventricle. And in the current era, now, there are many congenital lesions that eventually require placement of a pacemaker or an internal cardio defibrillator lead. And these can also create regurgitation. So a very wide range of lesions.

Now the important thing from a patient or family standpoint, and from a physician's standpoint, is the timing of surgery. And this can be actually quite difficult, particularly in children, because many of these leaky valve lesions have minimal symptoms. Sometimes symptoms may not even be present. And it's important to know that there could be quite advanced disease present even in the absence of symptoms.

So what would symptoms include? The classic symptoms with leaky valves would be shortness of breath, fatigue, or in a very young child it may be failure to thrive, that is, poor weight gain. Symptoms may be very subtle, not keeping up with peers, more naps in the afternoon, going to bed earlier in the evening, something that only a parent might notice. Or patients may be completely asymptomatic and actually be doing everything quite well.

In any situation, we do an echocardiogram. And an echocardiogram really helps provide information that also helps with timing of the operation. Importantly, it will give us information about whether the ventricle is dilated or not, and whether the ventricle has any dysfunction or not. The presence of either of those two things would clearly prompt the need for intervention.

When ventricular function gets dilated, and then the atria, the receiving chambers get dilated, then arrhythmias may become present. And the onset or progression of arrhythmias also can precipitate the need for operation. Finally, if the surgeon is quite confident with their ability to repair the valve, even earlier operation may be considered in an effort to avoid abnormality subsequently developing with the ventricle.

Other imaging studies besides Echo, which includes two-dimensional and three-dimensional Echo, is really ideal to determine anatomy of the valve. It really is a roadmap for the surgeon to determine whether or not they can repair the valve. This often is complemented with either magnetic resonance imaging, or CT imaging, which gives important function about the ventricle, particularly the right ventricle, how large it is, and what the function of it is.

Now there are many techniques of repair. And very importantly, the success of repair has a high correlation with surgeon experience. You should specifically ask your surgeon how many he or she has done. There are a variety of repair techniques that get tailored toward the specific abnormality. Techniques might include mobilization of one or more leaflets. It might include augmenting, that is, increasing the size of a leaflet. It may involve placement of artificial cords, that is, artificial strings to take the place of some that may be absent or broken. And some include reducing the size of the annulus, sort of like tightening a belt around your waist. Sometimes this is done with suture alone. Sometimes this is done with artificial rings or bands.

As mentioned earlier, arrhythmia commonly may coexist. And if arrhythmias are present, then an arrhythmia procedure, often referred to as the Maze procedure, should also be added at the time of valve repair.

Now there can be some curveballs with all of these problems, particularly when patients are referred late for surgery. And there are other strategies that should be in the armamentarium of the surgeon when ventricular function is below normal. Some of these may involve re-routing the blood. Re-routing the plumbing, so to speak, of blood going back to the heart, so that the ventricle that a struggling has less of a workload to deal with. The most common re-routing procedure would be the bi-directional Glenn shunt, where blood going back to the heart is diverted directly to the lungs in an effort to relieve the burden of the ventricle that is struggling.

And then, of course, there's medical therapy. Medical therapy in the perioperative period, but also, importantly, medical therapy in the long-term that would be driven and navigated by the cardiologist.

I can't emphasize the importance of a team approach, a multi-disciplinary approach, that is usually run by the surgeon, cardiologist, and anesthesiologist, but a wide variety of other allied health care professionals, individuals in radiology and imaging that all play a part in the care of these children.

The risk of surgery is largely determined by ventricular function and, in general terms, it is low when ventricular function is normal. An important piece of information for patients and families to know is that, when you are fixing a leaky valve the immediate response to ventricular function is actually to go down. That is to say, ventricular function gets worse initially, and then generally gets better with time. Hopefully, it returns to normal. But this is in a large part due to what the function of the ventricle is before surgery. Again, emphasizing the importance of proper timing of operation. Late results, that is survival, are also largely determined by ventricular function. Common questions are, how long will I live? Or how long will my child live? And will there be a need for other operations?

Generally speaking, survival is optimized when valves can be repaired as opposed to being replaced. But also, there is going to be a high probability for subsequent repair procedures down the road, depending upon how many have been done previous, and what the nature of the specific problem is. So in general, valve repair is preferred. Late survival is beneficial. There's low incidence of infection. And everything is optimized when ventricular function is preserved. Valve replacement may eventually be necessary. And there should be reasonable and sensible attempts at repair in the beginning and on repeated occasions before resorting to replacement.

We, of course, in our practice, have extensive experience with repair of all valves, mitral, tricuspid, and aortic valves. We emphasize the team approach, surgeon experience, and the importance of lifelong oversight cannot be overemphasized by the cardiologist who knows what to look for, knows how to monitor it, and knows when to refer for surgery. If anyone is interested in trying to obtain a consultation with either a surgeon or a cardiologist with your child who has been told that they have a valve problem that needs intervention, please feel free to let us know. We would be happy to review any information and provide recommendations accordingly. Thanks for listening.

Expertise and rankings

Pulmonary valve disease teamwork at Mayo Clinic

A team of heart specialists at Mayo Clinic evaluate people with pulmonary valve disease to determine the most appropriate treatment.

Mayo Clinic cardiologists and cardiovascular surgeons have extensive experience in pulmonary valve repair and pulmonary valve replacement.

Each year, Mayo Clinic cardiovascular surgeons perform about 90 pulmonary valve repairs and pulmonary valve replacements.

Health care providers in Mayo's Valvular Heart Disease Clinic specialize in diagnosing and treating people with pulmonary valve disease and other heart valve diseases.

Pediatric cardiologists and pediatric cardiovascular surgeons at Mayo Clinic's campus in Minnesota have experience treating children with pulmonary valve disease and other heart conditions.

Nationally recognized expertise

Mayo Clinic campuses are nationally recognized for expertise in cardiology and cardiovascular surgery:

  • The Adult Congenital Heart Disease Association (ACHA) has designated the Adult Congenital Heart Disease (ACHD) Clinic at Mayo Clinic's campus in Rochester, Minnesota, as an ACHA ACHD Accredited Comprehensive Care Center.

    This accreditation was achieved because the ACHD Clinic meets personnel requirements, offers specific medical services, and uses policies and procedures that help ensure the highest level of care for adults with congenital heart disease. This accreditation also signifies that Mayo Clinic has doctors with special expertise in diagnosing and treating congenital heart disease.

  • Mayo Clinic in Rochester, Minn., and Mayo Clinic in Phoenix/Scottsdale, Ariz., are ranked among the Best Hospitals for heart and heart surgery by U.S. News & World Report.
  • Mayo Clinic Children's Center in Rochester is ranked the No. 1 hospital in Minnesota, and the five-state region of Iowa, Minnesota, North Dakota, South Dakota and Wisconsin, according to U.S. News & World Report's 2022–2023 "Best Children's Hospitals" rankings.

The Adult Congenital Heart Disease Association (ACHA) has designated the Adult Congenital Heart Disease (ACHD) Clinic at Mayo Clinic's campus in Rochester, Minnesota, as an ACHA ACHD Accredited Comprehensive Care Center.

With Mayo Clinic's emphasis on collaborative care, specialists at each of the campuses — Minnesota, Arizona and Florida — interact very closely with colleagues at the other campuses and the Mayo Clinic Health System.

Learn more about Mayo Clinic's cardiovascular surgery and cardiovascular medicine departments' expertise and rankings.

Locations, travel and lodging

Mayo Clinic has major campuses in Phoenix and Scottsdale, Arizona; Jacksonville, Florida; and Rochester, Minnesota. The Mayo Clinic Health System has dozens of locations in several states.

For more information on visiting Mayo Clinic, choose your location below:

Costs and insurance

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people.

In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals, or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

Learn more about appointments at Mayo Clinic.

Please contact your insurance company to verify medical coverage and to obtain any needed authorization prior to your visit. Often, your insurer's customer service number is printed on the back of your insurance card.

More information about billing and insurance:

Mayo Clinic in Arizona, Florida and Minnesota

Mayo Clinic Health System

Clinical trials

Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions.

May 13, 2022
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Pulmonary valve repair and replacement