Daily Dose – New valve technology allows pediatric patients with congenital heart defects to come back to life faster and stronger than ever before

Atrium Health Levine Children’s Hospital is the first site in North Carolina and one of the first two hospitals in the Southeast region to offer the Medtronic Harmony™ Transcatheter Pulmonary Valve (TPV), an FDA-cleared treatment for patients pediatric and adult patients with tetralogy of Fallot (TOF).

TOF is a common type of congenital heart disease, accounting for about 10% of all heart defects that occur before birth. This condition causes a hole to form between the lower chambers of the heart and restriction of blood flow to the lungs. Most of these patients will eventually require valve replacement, and until recently about 80% of people with this condition had no valve replacement option other than open-heart surgery.

The new valve gives many of those remaining patients with TOF non-surgical valve replacement, limiting the number of future surgeries. Joseph Paolillo, MD, interventional cardiologist and chief of pediatric cardiology at Atrium Health Levine Children’s, and Matthew Schwartz, MD, medical director of the Pediatric and Adult Congenital Cardiac Catheterization Laboratory at Atrium Health Levine Children’s Hospital, implant the valve into the vein of the patient in the leg or neck.

“Our track record with TPVs is strong enough that we have been selected to be one of the first hospitals in the country to use this newly approved technology for patients with primarily leaky pulmonary valves,” said Dr. Paolillo. “We are excited to be part of the rollout of this new device and expect it to be a game changer in our field for low and high risk patients. We have performed 10 of these valve procedures so far.

As part of their initial full repair, patients with TOF have the hole in the heart and the narrowing of blood flow to the lungs repaired. Over time, depending on the type of repair, they again develop obstruction or leakage of blood flow from the lungs to the heart. There have been non-surgical options to help some of these patients for over 20 years. However, this new technology provides a treatment option for many of the remaining patients who require pulmonary valve replacement.

“As children age and transition into adulthood, the right side of the heart can become extremely large and this affects heart function,” Dr. Paolillo explained. “We know that patients will benefit from valve replacement to reverse some of the damage done to the right side of the heart and to protect their heart health.”

Many screened patients are eligible for the newly FDA-approved valve. Due to the size of the catheter, patients usually have at least 11 years to undergo the procedure. Once the valve is implanted, patients stay in the hospital overnight and go home the next day, which is a huge step forward considering the alternative would be open-heart surgery which requires a much longer recovery period. . Patients have their first follow-up visit two to four weeks after the procedure. Afterwards, they are checked every 6 to 12 months, depending on their state of health.

A quick return to a VERY active life: Renna’s story
Renna Linn, 13, is a bright eighth grader who loves sports and calls herself an ‘extreme athlete’ – staying active nearly 10 hours a week, including team workouts, tumbling, recreational conditioning and private lessons. However, unlike most athletes, Renna has lived her entire life with heart disease. She was born with TOF and had open heart surgery when she was three months old.

Fast forward 12 years later, Renna developed worsening regurgitation through her pulmonary valve, which meant she had symptoms like shortness of breath, dizziness and lightheadedness. “I was seeing stars all the time,” Renna says. She was struggling to catch her breath – certainly not ideal for someone as athletic as Renna.

Renna and her parents, Joel and Stephanie, knew Renna would eventually need another surgery to repair her heart valve. So when the Harmony™ Transcatheter Pulmonary Valve became available and Dr. Paolillo told Renna’s family that she would be a good candidate for this advanced technology, they knew it was their best chance to keep Renna too. healthy and active as possible.

“A lot of people don’t really understand that cheering is a very difficult sport with very technical somersaults,” says his father, Joel. “And we knew this procedure would have a shorter recovery time – six days versus six weeks, which made it the right decision for us.”

Although Renna was afraid of having surgery, she was more afraid of what might happen if she didn’t, so in October 2021 Renna had her valve replaced at the Cardiac Catheterization Lab. Within weeks, she was back doing all the activities she loves, including her awesome tumbling.

“I feel amazing!” she says. “A hundred times better than before. I’m so grateful to the whole team at Levine Children and how they’ve supported me through it all. I’m also grateful to my mum and dad because they’ve put a lot of love and effort to get me through this, they are literally the best parents ever.

So what’s next for Renna? She hopes to become a World Team athlete and try out for the US Olympic Cheer team. When she grows up, she wants to be an obstetrician-gynecologist who lives in Hawaii and surfs.

If there are other young people considering the procedure, Renna encourages them: “I know it can be scary, but you should definitely go ahead and do it because you don’t want to live your life in the fear. You don’t want to live with minimum capacity – you want to be at maximum.

Learn more about Levine Children’s innovative cardiac surgery and pediatric cardiology program.