Mitral valve replacement in the pediatric age group- a single institution experience
ABSTRACT BackgroundMitral valve replacement in pediatric patient is a difficult surgical task, with many intraoperative and post-operative considerations.
We conducted this study to evaluate the indications and early results of mitral valve replacement in children.
MethodsFrom January 2003 to July 2008, fifty-four children under the age of fifteen years underwent mitral valve replacement at our
institution. All children received a mechanical bi-leaflet or tilting disc prosthetic valve. All of them underwent valve replacement
on the basis of preoperative echocardiography and intraoperative assessment of valve pathology.
ResultsPreoperatively 65% of the children were in New York Heart Association (NYHA) class III and 35% of them were in NYHA class
IV. The cause of mitral valve disease was chronic rheumatic valve disease in 97% of cases and congenital in 3% of the cases.
In the rheumatic group 66% of them had severe mitral regurgitation as predominant lesion. The mean diameter of the implanted
valve was 27.17mm. There was no hospital or 30 day mortality. The mean follow-up period was 3.6 years. One patient died after
2 years from a stuck valve. Two other patients required thrombolysis for stuck valves. 53 patients are doing well at last
ConclusionsMitral valve replacement in children is a safe alternative to valve repair when the morphology is not suitable for repair,
with acceptable immediate and early outcomes.
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ABSTRACT: Prosthesis survival, growth, and functional status after initial mechanical mitral valve replacement (MVR) in children <5 years of age are poorly defined. The experience of the Pediatric Cardiac Care Consortium (45 centers, 1982 to 1999), which included 102 survivors after initial MVR, was analyzed. Median follow-up: 6.0 years (interquartile range: 3.0 to 10.6 years; 96% complete). Twenty-nine survivors had undergone a second MVR at an interval of 4.8+/-3.8 years after initial MVR. Reasons for second MVR were prosthetic valve stenosis 24 (83%), thrombosis 4 (14%), and endocarditis 1 (3%). For those who had second MVR, prosthesis sizes were: first MVR 19+/-2 mm and second MVR 22+/-3 mm, and their body weight increased from 7.4+/-2.8 kg to 16.8+/-10.5 kg. To identify risk factors for having a second MVR, the 29 second MVR survivors were compared with the 73 who did not have a second MVR on first-MVR demographic and perioperative variables. By univariate analysis, patients with shorter prosthesis survival were younger, weighed less, had smaller prostheses, greater ratio of prosthesis size:body weight, were less likely to have a St. Jude prosthesis and more likely to have Shone's syndrome. By multivariate analysis prosthesis survival was predicted only by first MVR age: odds ratio (OR) 7.7 (95% confidence interval [CI] 2.6-22.7) and prosthesis size: OR 6.8 (95% CI 2.6-18.2). High risk patients (age <2 years and prosthesis <20 mm at first MVR) had an OR=46.3 compared with low-risk patients (age >or=2 years and prosthesis >or=20 mm at first MVR) over similar follow-up intervals. Using first-MVR weight-matched controls, body weight increased similarly for patients <2 years old who had a second MVR versus those who did not. Prosthesis size, however, differed significantly, with second MVR patients having smaller prostheses at first MVR (18.7+/-0.8 mm versus 22.4+/-3.6 mm, P=0.017). An estimate of current New York Heart Association (NYHA) functional status was class 1 in 76%, class 2 in 22%, and classes 3 or 4 in 2%. Prosthesis survival can be predicted based on first MVR age and prosthesis size. Somatic growth is comparable regardless of the need for second MVR. There is an increment in prosthesis size at second MVR, suggesting continued annular growth. Significant limitation of function after MVR is uncommon. MVR may be an appropriate strategy for children <5 years old despite the risk of second MVR in the youngest patients in whom the smallest prostheses are used.Circulation 09/2003; 108 Suppl 1:II174-9. · 15.20 Impact Factor
- American Heart Journal - AMER HEART J. 01/1991; 121(2):557-568.
Article: Antithrombotic therapy in children.Chest 02/2001; 119(1 Suppl):344S-370S. · 7.13 Impact Factor