I have a 7 yr old with tuberous sclerosis complex, severely affected in the brain (multiple growths, lesions, 3 SEGAs) with epilepsy well controlled through medication and keto diet. She is g-tube fed. She has a recently discovered heart murmur with mitral valve regurg, she has 40 growths in kidneys all less than 1 cm. she has been vomiting for 6 months with no respite. All blood tests come back normal (white counts, amylase, liver panel, metabolic panel, etc), upper GI showed no abnormalities.