Mitral valve replacement in the pediatric age group- a single institution experience

Department of CVTS, G.B. Pant Hospital, New Delhi, India
Indian Journal of Thoracic and Cardiovascular Surgery 03/2009; 25(1):7-11. DOI: 10.1007/s12055-009-0002-3


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
follow up.

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: The purpose of this paper is to present the short- and long-term results of prosthetic valve replacement in children. During a 7-year period that ended in April 1985, 186 children, ages 1 to 20 years, underwent valve replacement; there were 55 (30%) aortic valve replacements, 95 (51%) mitral valve replacements, and 36 (19%) multiple valve replacements. Ninety-four percent of the lesions were rheumatic in origin, 4% were congenital, and 2% were infectious. Of 223 valves replaced, 175 (78%) were mechanical valves and 48 (22%) were heterografts; the latter were in the mitral position in all but three patients. Surgical mortality rates were 3.6%, 4.2%, and 19.4% respectively for aortic valve, mitral valve, and multiple valve replacements. Five-year actuarial survival was 91% for aortic valve replacement, 82% for mitral valve replacement and 60% for multiple valve replacement. Major events included reoperation in 34 (with three deaths), progressive myocardial failure that led to death in 10, sudden unexpected death in two, thromboembolic complications in 19 (death in five), subacute bacterial endocarditis in five (two deaths), and bleeding that required transfusion in two patients. Five-year complication-free actuarial survival rates were 83% for aortic valve replacement, 63% for mitral valve replacement, and 57% for multiple valve replacement. The respective five-year complication-free survival rates were 83%, 48%, and 43%. Significant morbidity and mortality rates are associated with valve replacement. Therefore every effort should be made to preserve the native valve by plastic reparative procedures. When prosthetic replacement of mitral valve is contemplated, our data would suggest that heterografts should not be inserted in children 15 years of age or younger, although heterografts may be used in children over 15 years of age with the expectation of valve survival comparable to that of mechanical valves. When complications that are associated with anticoagulant therapy were reviewed, platelet inhibiting drugs seem quite satisfactory in patients with aortic valve replacement; patients with mitral valve replacement seem to require warfarin therapy, and warfarin must be used in patients with multiple valve replacement to reduce the risk of thromboembolic complications.
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