Sensitivity to valves & homografts

[Tiffany1916]

At 8 weeks of age, my son with born with Truncus Arteriosus with a right aortic arch, mild pulmonary branch stenosis, small aortic insuffieciency.  His original repair occured in November of 2002 at 12 weeks of age during which he received a homograft.  His homograft was replaced in October of 2003 and he was given a dacron conduit with a porcine valve.  This conduit lasted 6 and a half years, however, it created a anaphylactic reaction to porcine gelatin which had not been a problem prior to October 2003.  In July of 2010, my son underwent his third open-heart surgery and received a homograft to replace his dacron conduit.  During the first 4 weeks of post-op, he developed large hives on various parts of his body (6 inches by 2-3 inches) and occasionally ran a low-grade fever.  His RV gradient in August of 2010 was 15 mm and his RV pressure was 25-30.  In November of 2010, his RV gradient was 30 mm and his RV pressure was 35-40.  

Is it possible his body has a sensitivity that will create the homograft to fail again within a 1 year time frame?  

[cody772]

My daughter is nine years old and recently diagnosed with borderline type two diabetis. The doctor also found with blood work that her thyroid glands in her neck were 2/3 larger than what they should be. It was at 3.0. At the time her weight was 114. This was about two months ago. Her weight now is 100. She was prescribed Metformin and Synthroid. Along with a diet that has worked well for the weight control.I dont understand why she was diagnosed with high glucose when the blood work with a fast shows glucose in the normal range at 107. The following was in bold on the paperwork. Alkiline Phosphatase @ 380 Normal rang showed 0-186.     Bun/Creatine @27.5 Normal ratio 8-20.    Triglycerides @ 168. Normal ranged 45-150.   MCV @ 80.7 Normal range 82-100. Neutrophils @ 47.5 Normal ratio 50-70.   Glucose was not in bold and again showed 107 with a normal ratio showing 60-115.  Any opinion would be a blessing. Please help us to understand. Thanks and God bless all of you.  

[Jeffrey R Boris, M.D.]

Dear Tiffany,

At this point, the answer is yes.  Obviously, I don't exactly know to what he had his allergic reaction recently, and he certainly seems like his immune system is a bit more "revved up" than we'd like to see, but I can't also say that his earlier response is related to how he will do now.  I certainly hope that he will do well and be able to get more like 5 to 10 years out of his homograft, which is what we tend to see as the kids get older.

[Tiffany1916]

Thank you for your response.  

Am I clear to understand that you do not feel that the short 10 month life of his original homograft would necessarily create a need for any concern with his current situation?

Thank you again.
Tiffany

[Jeffrey R Boris, M.D.]

Dear Tiffany,

You bring up an interesting concern.  First off, we don't know for sure whether the hives that your son developed had anything to do with the homograft that was placed.  In fact, a homograft is not porcine at all--it is human.  Therefore, his hives most likely were a coincidental finding due to something else.  That said, he could have had some aspect of an immune response to something in the way the valve was preserved.

We know that the younger you are when you receive a homograft, the more exuberant (less tolerant) the body is of the tissue and the less time the homograft will last.  And, we have not perfected any type of immunosuppression that decreases the body's attack on these valves.  I cannot say for sure whether his immunologic response will mean that his homograft will have a shorter functional lifespan, or not.  I doubt that it will fail within one year, though, but it is not out of the question.  The odds are on his side that the homograft will last longer, though.

[Tiffany1916]

Just a correction....He was diagnosed at 8 weeks with Truncus and not born at 8 weeks.
Thanks!