Congenital Heart Valve Disease and Minimally-Invasive Surgery: What Should Patients Know?

Bicuspid aortic valve and mitral prolapse are two of the most common congenital heart valve problems and often go undiagnosed until adulthood, when symptoms arise. Other times, congenital heart problems require immediate surgery after birth and several more interventions as the child grows. A common question we get from both adult patients with congenital heart valve disease and from parents who have children with congenital heart disease is, “Can minimally invasive techniques be used to treat patients with congenital heart valve disease?”

Adam Pick, the founder of HeartValveSurgery.com, recently attended the Endoscopic Surgeons’ Club Meeting in Cincinnati, Ohio, where he met with Dr. Chris Malaisrie to learn more about minimally invasive options for patients with congenital heart valve disease. Dr. Malaisrie is heart valve expert with a specialty in minimally invasive surgery at Northwestern Medicine in Chicago, Illinois.

Facts About Minimally Invasive Techniques for Congenital Heart Valve Disease

Here are the key insights shared by Dr. Malaisrie:

• The two common congenital disorders may be asymptomatic, but should not be ignored. “Minimally invasive heart surgery can be an option for patients with congenital heart disease,” said Dr. Malaisrie. “Fortunately, two of the most common congenital heart defects are benign for a very long time. I’m talking about bicuspid aortic valve and mitral valve prolapse. You’re born with these sorts of things, and they can get worse over time and occasionally need surgery later. So, the first thing I’d like to emphasize is routine follow-up and paying attention to disease that is severe even without symptoms.”

• Interventions for bicuspid aortic valve. Dr. Malaisrie said, “There are multiple ways to fix bicuspid aortic valve. It depends on how the bicuspid valve gets diseased. It could either leak or it could become too tight. When it’s too tight, we’re talking about replacing the aortic valve. When the valve is leaky, we can repair it.” Dr. Malaisrie explained that patients under 50 years old are well within guidelines to receive a mechanical valve for a straightforward aortic valve replacement. “I think a minimally invasive, non-sternotomy approach is an excellent option. We can replace the valve between the ribs on the right side with direct vision, endoscopy, or robotics. The patient can achieve a very quick recovery after a minimally invasive aortic valve replacement.”

• A minimally invasive option for mitral valve prolapse. “When mitral valve prolapse progresses to the severe stage, valve repair is an excellent option. This can also be performed through small incisions between the ribs on the right side using endoscopy or robotic approaches, again achieving a very quick recovery for the patients.”

• Recommendations for patients who have very complex cases of congenital heart disease with related valvular disorders. “Congenital heart disease can range from very simple things, such as atrial septal defects (ASDs) or ventricular septal defects (VSDs), which are small windows within the heart that can cause shunting. Shunting can then cause short-circuiting of blood in the heart. These can both be easily repaired with minimally invasive approaches and are usually taken care of while the patient is a child or an infant.” Dr. Malaisrie explained that as patients with more complex cases progress to adulthood, whether they’ve had treatment for their adult congenital heart disease or not, they should find a center that specializes in adult congenital heart disease. The center should have a cardiologist, an interventional cardiologist who can offer percutaneous options, and a surgeon who is experienced in both open and minimally invasive approaches, providing various treatment options for patients with very complex cases. Adam Pick commented, “I can’t thank you enough for shining the light on the idea of having a multidisciplinary team along with the lifetime management of a congenital heart condition.”

Thanks Dr. Malaisrie and Northwestern Medicine!

On behalf of all the patients in our community, thank you, Dr. Chris Malaisrie, for everything you and your team are doing at Northwestern Medicine in Chicago, Illinois!

Related links:

• Read Northwestern Medicine’s Surgeon Spotlight on Dr. Malaisrie
• Check out Dr. Malaisrie’s Interactive Surgeon Profile
• Explore Northwestern Medicine’s Heart Valve Microsite

Keep on tickin,
Adam

P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. Malaisrie below.