Posted on June 7th, 2012 under Heart Valve Replacement, Surgeons & Clinics.
I recently received a question from Randy about his teenage daughter who requires surgery due to a leaking aortic valve.
In his email, Randy writes, “Hi Adam – My daughter, Haley, has severe aortic valve regurgitation. She is 14-years old and was diagnosed at age 9. She is asymptomatic but conditions have progressed to a point where surgery is warranted. My wife and I are struggling with choosing the right procedure. Our medical team has recommended valve repair first and valve replacement second. Based on all information gathered to this point, we are leaning towards mechanical valve replacement for Haley. What do you think? Thanks, Randy”
I wanted to provide Randy an expert opinion, so I contacted Dr. Fayyaz Hashmi from Mercy Health System in Toledo, Ohio. I recently met Dr. Hashmi at the Heart Valve Summit. Beyond being a very experienced surgeon, with over 10,000 procedures completed, Dr. Hashmi is a very kind, soft-spoken man with an altruistic and global approach to cardiac care.
In response to Randy’s question, Dr. Hashmi raised several interesting points:
Morning Adam, a few things to consider in Haley’s case: Did she have a congenital aortic stenosis as a newborn and was it opened up with a balloon which has gradually become incompetent? It is very rare to have aortic valve regurgitation in children as an isolated lesion. Typically, it is either associated with a hole in between two lower chambers. Or, the disorder is a result of Marfan’s syndrome? Lastly, although rare in the United States, it could be due to rheumatic fever. However, valve damage from rheumatic fever usually involves the mitral valve as well.
Dr. Hashmi then addressed a potential treatment plan for Randy’s daughter:
Other than for Marfan’s syndrome, I think best solution for Haley is to have an initial repair with the knowledge that there is a possibility of repeat surgery 15 to 20 years down the road. This approach will give her a time span free of need for anticoagulants while she is becoming an adult. One day, she might want to have a family. Later on, if needed, she could have a replacement with a mechanical valve which will be durable for rest of her life. It is not recommended to have a Ross procedure for aortic valve regurgitation since the need for re-operation could be as high as 20%.
Lastly, Dr. Hashmi addressed Marfan’s syndrome and potential next steps:
If she has a Marfan’s type of disease and has a large aortic root, a valve sparing root replacement with preservation of her own valve is the best choice. I hope this helps her parents in making a decision. Where to go for her surgery, depends on their geographic location. There are centers of excellence on both coasts as well as in the midwest and south.
Thanks to Randy for his question and a special thanks to Dr. Fayyaz Hashmi for sharing his clinical expertise with our community.
Keep on tickin!