Jonathan Chen, MD: Just like each child is different, so is each heart valve. I'm Jonathan Chen, a surgeon at the Pediatric Heart Valve Center at Children's Hospital of Philadelphia. My team is one of the most experienced in the country in valve repair and replacement. This video will help you understand the kinds of repairs we perform.

To better understand aortic valve repair, let's first take a look at the anatomy of the heart. This is your heart. It has four chambers and four valves. Blood passes through a valve before entering or leaving each chamber of the heart. The heart's lower chambers are called ventricles. The left ventricle pumps oxygen-rich blood through the aortic valve and into the aorta, the largest artery in the body.

Blood travels from the aorta to blood vessels throughout the body, delivering oxygen and nutrients.

Heart valves are made of flaps of tissue called leaflets. These leaflets work like one way doors, opening to let blood move forward, and closing to keep blood from flowing backward. Watch how the leaflets move from another angle, opening to let blood move forward and closing to keep blood from flowing backward.

To work properly, all three leaflets must meet when they close. If the valve doesn't completely close, blood leaks back into the heart. This is called regurgitation. Aortic regurgitation develops when the aortic valve leaflets become retracted, prolapsed, or distorted in some other way. A retracted valve is drawn in and the leaflets don't meet when they close. To repair a retracted valve, a surgeon usually performs a valve extension.

This means the surgeon takes a small amount of the strong tissue covering the heart, called the pericardium, and uses it to lengthen the leaflets. This does not affect the function of the pericardium. A prolapse valve has leaflets that droop. A surgeon will adjust or remove parts of the valve until all the leaflets meet.

In some cases, a surgeon may replace entire leaflets with tissue from the pericardium. This is called the Ozaki Procedure. Another cause of valve damage is infection. Infection may cause a perforation or small hole in the valve leaflets. A surgeon will use tissue from the pericardium to patch the hole.

Aortic valve repair is highly individualized. At the Valve Center at Children's Hospital of Philadelphia, our team uses cutting edge imaging to view each patient's heart before surgery. This allows us to develop a personalized surgical plan based on your child's unique anatomy. We work together and with you, to make the best decisions for your child before, during, and after surgery.

Jonathan Chen, MD: A mechanical valve can be used to replace a damaged or diseased aortic or mitral valve. I'm Jonathan Chen, a surgeon in the Pediatric Heart Valve Center at Children's Hospital of Philadelphia. My team is one of the most experienced in the country in valve repair and replacement. To better understand mechanical valve replacement, let's first take a look at the anatomy of the heart. This is your heart. It has four chambers and four valves.

The upper chambers are the left atrium and the right atrium. The lower chambers are the left ventricle and the right ventricle. Before entering or leaving each chamber of the heart, blood passes through a valve. The mitral valve is between the chambers on the left side of the heart. The left atrium receives oxygen-rich blood from the lungs and pumps it through the mitral valve to the left ventricle.

The left ventricle then pumps the blood through the aortic valve and into the aorta, the largest artery in the body. Blood travels from the aorta to blood vessels throughout the body, delivering oxygen and nutrients. Heart valves are made of flaps of tissue called leaflets. The leaflets work like one way doors, opening to let blood move forward, and closing to keep blood from flowing backward. Watch how the leaflets move from another angle, opening to let blood move forward and closing to keep blood from flowing backward.

The leaflets are attached to a strong tissue called the annulus. The annulus helps maintain the shape of the valve. If a valve is diseased or damaged, it can be surgically removed and replaced with a mechanical valve. A mechanical valve is made of metal and plastic. A thick cloth surrounds the valve. Just like your child's heart valves, the leaflets in the mechanical valve open and close to keep blood flowing through your heart. The mechanical leaflets make a soft clicking noise as they open and close. You can hear it, if you have a mechanical valve. Patients adjust to the sound and are eventually able to ignore it. You might have heard of adults who have bioprosthetic valves, made of tissue from pigs or cows.

These valves have a high risk of becoming hard over time, in a process called calcification, causing these valves to last less than three to five years in children. During a mechanical valve replacement, your surgeon will remove the diseased or damaged valve and choose the right size replacement valve for your child.

The surgeon will suture the mechanical valve to the annulus using the sewing ring or cloth rim of the valve. At the Valve Center at Children's Hospital of Philadelphia, our team uses cutting edge imaging to view each patient's heart before surgery. This allows us to develop a highly personalized surgical plan based on your child's unique anatomy.

In babies and toddlers, a mechanical valve will need to be upsized as your child grows. While a teenager may only need one valve operation, a baby or toddler will likely need two or three re-operations over time. A mechanical valve has an increased risk of infection. It's important to tell your doctor if your child has a serious cut or lesion because they may need antibiotics to prevent infection from traveling to the heart.

It is possible for scar tissue, called pannus, to grow around the mechanical valve. Too much scar tissue can make it hard for the leaflets to move, requiring a replacement valve. Patients with mechanical valves must take daily blood thinners to prevent clotting on the valve. If a blood clot detaches from the valve and travels to another area of the body, this can be life-threatening. Blood thinning medication needs careful management.

Dosage must be monitored regularly, which can be done at home. When your child is facing heart valve surgery, we know there are difficult decisions to make. Our experts work together and with you, to make the best decisions for your child before, during, and after surgery.

Jonathan Chen, MD: The Ross procedure is a surgical technique that can be used to replace a damaged or diseased aortic valve. I'm Jonathan Chen, a surgeon in the Pediatric Heart Valve Center at Children's Hospital of Philadelphia.

My team is one of the most experienced in the country in valve repair and replacement, and we regularly perform the Ross procedure. To better understand the procedure, let's first take a look at the anatomy of your heart. This is your heart. It has four chambers and four valves. Blood passes through a valve before leaving each chamber of the heart. The valves prevent the backward flow of blood.

To understand the Ross procedure, you'll need to know about the aortic valve and the pulmonary valve. The heart's lower chambers are called ventricles. The left ventricle pumps oxygen-rich blood through the aortic valve and into the aorta, the largest artery in the body. Blood travels from the aorta to blood vessels throughout the body, delivering oxygen and nutrients. Blood that has traveled through your body and is now low in oxygen goes into the right side of the heart.

The right ventricle pumps the blood through the pulmonary valve, into the pulmonary artery and to the lungs for more oxygen.

If the aortic valve is diseased or damaged, it can be surgically removed and replaced with the body's own healthy pulmonary valve. This is known as the Ross procedure. Here's how it works. First, the surgeon must detach the coronary arteries from the aorta. The coronary arteries are the blood vessels that feed oxygenated blood to the heart.

Then the surgeon will remove the diseased or damaged aortic valve, as well as the aorta surrounding the valve. The healthy pulmonary valve, surrounded by a cylinder of pulmonary artery, is then removed from its usual location and sewn into the aortic position. This is called an autograft. The surgeon then reattaches the coronary arteries to the autograft.

A donor cadaver pulmonary valve surrounded by a cylinder of pulmonary artery is then attached replacing the original pulmonary valve. This is called a homograft.

The Ross procedure is a highly technical surgery. At the Valve Center at Children's Hospital of Philadelphia, our team uses cutting edge imaging to view each patient's heart before surgery. This allows us to develop a highly personalized surgical plan based on your child's unique anatomy. As with any heart surgery, the Ross procedure has advantages and disadvantages.

Because the Ross procedure uses the patient's own tissue, there's little risk of clotting. This means your child won't need to take long-term blood thinners. The pulmonary valve in the aortic position, remember this is called the autograft, continues to grow with your child, so it won't need to be upsized as your child grows. Sometimes, however, the autograft has to be replaced because of wear. The donor pulmonary valve, remember this is called the homograft, does not grow.

In kids, it will eventually need to be upsized, which will require a future operation. In teenagers and adults, the homograft won't need to be upsized, but the valve inside the homograft might become leaky. If that happens, the valve can probably be replaced through a catheterization instead of surgery. Our team is a world leader in the Ross procedure.

We work together and with you, to make the best decisions for your child before, during, and after surgery.