Pediatric Heart Valve Center
Who We Treat | Highlights | Team | Location | Appointments | Resources
The Pediatric Heart Valve Center at Columbia is dedicated to improving the quality of care for children and adults with congenital heart valve malformations. We've brought together a team of experts from across Columbia University Irving Medical Center (CUIMC) to offer innovative surgical and minimally invasive techniques for heart valve repair and replacement, backed by an unparalleled integrated research program continuously developing better and safer treatment options.
- The Pediatric Heart Valve Center is one of the largest and most successful centers for treating heart valve congenital malformations in the nation, safely performing over 700 open-heart procedures a year.
- Our center has an international reputation for treating some of the most complex cases; our surgeons routinely treat patients referred from other institutions.
- We are one of just a few centers in the US to offer hybrid cardiac surgery for infants and children, combining conventional surgical methods with minimally invasive, catheter-based interventional strategies.
To make an appointment with our center, call us at (212) 305-5975 or email us at dk2757@cumc.columbia.edu.
Who We Treat
The Pediatric Heart Valve Center treats all children and adults with heart valve congenital malformations. We've developed innovative and creative solutions to address even the most complex conditions.
Conditions We Treat
Aortic Valve
The most common aortic valve lesion in childhood is aortic stenosis. Left ventricular outflow tract (LVOT) obstructive lesions account for approximately 6 percent of cases of congenital heart disease in children. Obstruction can occur at the valve (valvar), below the valve (subvalvar), or above it (supravalvar).
The most common form of LVOT obstruction in children is valvular aortic stenosis (AS), accounting for as many as 71 to 86 percent of patients. In most cases of valvar AS, systemic blood pressure and cardiac output remain normal because of a compensatory elevation in left ventricular (LV) systolic pressure and total cardiac work. More severe disease in childhood, however, is not uncommon, and approximately 10 percent of patients develop heart failure during the first year after birth. Of these, approximately two-thirds become symptomatic by two months of age, and most will have symptoms before six months. Infants with critical AS, the most severe form, present with signs of severe heart failure or cardiogenic shock in the neonatal period or shortly thereafter, following closure of the ductus arteriosus.
Definitive therapy consists of reducing the degree of valvar stenosis. The initial treatment can be balloon valvuloplasty or surgery. However, patients who develop severe aortic regurgitation (AR) following balloon dilation will require surgical treatment. Valve intervention in the neonatal period commonly requires further intervention as the patient ages and grows; eventually some valves will need to be replaced.
Pulmonary Valve
Pulmonary valve stenosis (PS) is a common congenital heart defect, occurring in 6 to 8 out of every 10,000 live births and is characterized by obstruction in blood flow from the right ventricle (RV) to the pulmonary arteries. PS can occur in isolation or be associated with other types of cardiac defects. Valvar stenosis is the most common type of PS, and is typically characterized by fused or absent commissures with thickened leaflets of the pulmonary valve. Severe PS is associated with RV hypertrophy and infundibular muscle hypertrophy, which can cause further dynamic obstruction below the pulmonary valve during RV contraction.
Critical PS is the most severe case of valvar PS, resulting in an inadequate pulmonary blood flow. As a result, survival for affected infants is dependent upon maintaining a patent ductus arteriosus for pulmonary blood flow. Dysplastic pulmonary valves are another form of valvar PS and are less common. These valves are often irregular, with prominent leaflet thickening leading to a small (hypoplastic) valve annulus and reduced mobility. This anatomic variant is associated with Noonan syndrome.
Pulmonary valve regurgitation is often secondary to the malformation tetralogy of Fallot. Repair of this condition in infancy typically leaves the pulmonary valve incompetent and years later this incompetence causes dilation and damage to the right ventricle.
Tricuspid Valve
Ebstein anomaly is a congenital malformation that is characterized primarily by abnormalities of the tricuspid valve and right ventricle. The clinical presentation of Ebstein anomaly varies widely, ranging from the critically ill neonate to the asymptomatic adult, depending upon the degree of anatomic abnormality. The estimated risk of Ebstein anomaly in the general population is 1 in 20,000 live births, with no predilection for either gender.
Clinically the anomaly may be fatal in utero or shortly after birth if severe cardiomegaly and heart failure are present. Children and adults with marked tricuspid leaflet displacement may have severe regurgitation, right-sided heart failure, elevated right atrial pressures, and significant cyanosis due to right-to-left interatrial shunting with or without functional/anatomic pulmonary valve atresia. In contrast, patients with mild apical displacement and mild dysfunction of the tricuspid valve (mild tricuspid regurgitation) may remain asymptomatic through adulthood or present in adulthood with arrhythmia or paradoxical embolic event.
Contemporary repair techniques focus on a cone-type of reconstruction. This includes mobilization of all available valve leaflets and joining them to result in 360 degrees of leaflet tissue that is re-anchored at the level of the true annulus. The atrialized right ventricle is vertically plicated. Several other repair techniques, involving annuloplasty and/or ventricular plication, have also been described and used. If tricuspid repair is not possible and the patient has reached adult size, tricuspid valve replacement may be necessary. A biologic prosthesis is usually chosen because of the high incidence of thrombosis with a mechanical prosthesis placed in the right heart, particularly when the right ventricular function is poor.
Mitral Valve
Mitral stenosis (MS) is a condition characterized by obstruction of blood flow across the mitral valve from the left atrium to the left ventricle. The mechanical obstruction leads to increases in pressure within the left atrium, pulmonary vasculature, and right side of the heart. Most cases of MS are caused by rheumatic heart disease and congenital malformations (including parachute mitral valve). If untreated, MS often progresses to significant symptoms (eg, difficulty breathing and fatigue) and serious complications (eg, pulmonary edema, systemic arterial embolism, pulmonary hypertension, and death). Medical therapy can relieve symptoms but surgical or percutaneous intervention is required to relieve the obstruction to flow.
Mitral regurgitation (MR) is a relatively common valvular disorder that can progress to ventricular decompensation and the need for mitral valve surgery. Congenital causes of MR include cleft mitral valve, which may be isolated or associated with other anomalies. MR is a common complication following atrioventricular canal defect repair, particularly in patients with preoperative MR. The only effective treatment is surgical valve repair or valve replacement.
Stories & Perspectives
State of the Union: Pediatric Heart Surgery in 2024
An interview with pediatric heart surgeon Dr. David Kalfa about the latest and most cutting-edge advancements in pediatric heart surgery.
Services We Offer
Our center evaluates all patients for less invasive treatment options, which may allow the surgeon to treat a condition with a single operation rather than a series of procedures.
Interventional Cardiology Services
The Interventional Cardiology Team within the Pediatric Heart Valve Center is one of the few teams in the US with a dedicated congenital cardiac catheterization laboratory and fully trained interventional pediatric cardiologists with vast experience in balloon valvuloplasty of the aortic, mitral, and pulmonary valves.
Hybrid Heart Surgery
We are one of just a few centers in the US to offer hybrid cardiac surgery for infants and children. Hybrid heart surgery combines conventional surgical methods with minimally invasive, catheter-based interventional approaches to permit much smaller incisions, avoid cardiopulmonary bypass, and promote a faster recovery.
Non-Invasive Imaging Care & Expertise
Our non-invasive cardiac imaging team plays a critical role in the peri-operative assessment of congenital heart valve disease. At Columbia University Irving Medical Center, we have an extremely high-volume, non-invasive imaging lab that includes fetal, transthoracic, and transesophageal echocardiography, as well as cardiac MRI and CT. We perform roughly 12,000 transthoracic echocardiograms and 1,000 transesophageal echocardiograms a year.
A Dedicated Research Lab
The Pediatric Heart Valve Research Lab aims to devise solutions in cardiovascular fundamental and translational research areas. Our projects are at the intersection of biomedical engineering, mechanical engineering, polymer science, smart material development, mathematical sciences, clinical cardiology, cardiothoracic surgery, and developmental biology. Our ultimate goal is to help patients with heart disease by developing better diagnostic tools and more efficient therapeutic devices.
Stories & Perspectives
From NYP’s Health Matters: Saving Two Babies’ Lives With One Pioneering Approach to Heart Valve Transplantation
In a first-of-its-kind “domino” transplant in infants, cardiac surgeons at Columbia/NYP performed a heart transplant in one baby, and then transplanted valves from her old heart into another infant — saving two lives and paving the way to save more.
Program Highlights
A Leading Center for Pediatric Heart Valve Treatment
The Pediatric Heart Valve Center is one of the nation's largest and most successful pediatric cardiology and cardiac surgery centers focusing on heart valve congenital malformations. We provide patients with congenital heart defects treatment options that would have never been thought possible just a short time ago, with outcomes that are among the best in the nation.
A Multidisciplinary Team of Experts
Every patient of the Pediatric Heart Valve Center is cared for by a dedicated team of experts in pediatrics, cardiology, and cardiac surgery. Our leadership team reviews every case weekly, and our Heart Valve Clinic provides close follow-up to ensure the best outcomes and to detect any potential complications early.
Improved Efficiency with Virtual Surgery
Thanks to advanced imaging techniques, we can now create a 3D virtual model of a child's heart before their operation. This approach allows us to better plan the procedure, anticipate challenges, and significantly decrease the time spent in the operating room. It also helps parents have a better understanding of their child's condition and what surgery will entail.
Pioneering Partial Heart Transplants
Partial heart transplants are an effective way for one donated heart to help save more than one life. This approach can create what is known as a domino transplant—when one patient receives a heart transplant and then donates healthy parts of their heart to another patient or patients. Columba pediatric heart surgeons recently performed the first-ever domino heart valve transplant in infants. Our center has expanded access to heart valve transplantation surgery with ground-breaking advances in organ preservation.
Biventricular Repair That Grow Along With Your Child
Traditional single-ventricle surgeries treat single-ventricle defects by helping one ventricle do the work of two—but this approach places extra strain on the body and often leads to a heart or multi-organ transplant. Complex biventricular repair is a new approach that strategically adjusts blood flow between the heart's chambers and encourages the heart to adapt and grow. Thanks to our advanced cardiac imaging capabilities, Columbia is able to offer this approach to more patients than ever.
The Latest in Robotic Cardiac Surgery
Robotic Surgery is a minimally invasive surgical technique that pairs state-of-the-art technologies with surgical expertise to treat a wide range of heart conditions. Using a robotic arm configured with surgical instruments and cameras, a skilled surgeon can perform even the most complex and delicate surgical maneuvers. Our center is one of the only programs in the nation offering robotic surgery for pediatric heart conditions.
Unmatched Interventional Cardiology Care
Our interventionalists have helped pioneer the investigation of multiple new catheter-placed devices and have participated in nearly every major multicenter FDA trial for pediatric cardiac catheter-based devices over the past 15 years. More than 1200 complex procedures are performed annually in patients with congenital heart disease, from premature neonates to adults. Our interventional cardiologists have developed many of the pediatric interventional procedures that have become the standard of care worldwide.
Access to Cutting-Edge Research
Our integrated research program helps ensure we can always bring you the best and safest treatment options. Our research efforts are strengthened through our academic affiliations with both Columbia University and Cornell University and our position within New York City, which is currently developing as the largest and most active city in the US and the world for Biotech companies and start-ups.
Our Team
Pediatric Heart Surgeons
David Kalfa, MD, PhD
Director, Pediatric Heart Valve Center
Emile Bacha, MD
Director, Congenital Heart Center
Pediatric Cardiologists
Christopher Petit, MD
Chief, Pediatric Cardiology
Alejandro Torres, MD
Director, Pediatric Interventional Cardiology
Our Location
Morgan Stanley Children's Hospital of NewYork-Presbyterian
3959 Broadway (165th Street and Broadway), CHN-274
New York, NY 10032
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Make an Appointment
To make an appointment with the Columbia Pediatric Heart Valve Center, call us at (212) 305-5975. For second opinions or to contact one of our physicians directly please email us at dk2757@cumc.columbia.edu.
We accept a number of insurance plans, and our team can help confirm your coverage. Documents and records can be faxed to us at (212) 305-4408.