Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-28T15:04:26.608Z Has data issue: false hasContentIssue false
  • English
  • Français

Replacement of the mitral valve in children—an analysis of 130 cases

Published online by Cambridge University Press:  19 August 2008

Fekria Abid ,
Manoubia Fekih ,
Adel Khayati ,
Habiba Drissa ,
Wafa Fehri  and
Abdelfettah Abid
Fekria Abid*
Affiliation:
Department of Pediatric Cardiology, Hopital la Rabta, Tunis
Manoubia Fekih
Affiliation:
Department of Pediatric Cardiology, Hopital la Rabta, Tunis
Adel Khayati
Affiliation:
Department of Pediatric Cardiology, Hopital la Rabta, Tunis
Habiba Drissa
Affiliation:
Department of Pediatric Cardiology, Hopital la Rabta, Tunis
Wafa Fehri
Affiliation:
Department of Pediatric Cardiology, Hopital la Rabta, Tunis
Abdelfettah Abid
Affiliation:
Department of Pediatric Cardiology, Hopital la Rabta, Tunis
*
Dr. Fekria Abid, Department of Pediatric Cardiology, Hopital la Rabta, Tunis 1007, Tunisia.
Get access Rights & Permissions [Opens in a new window]

Summary

Replacement of the mitral valve was performed in 130 children less than 15 years of age—115 for rheumatic and 15 for congenital disease. Early mortality was 5.4%. Of 123 survivors, 112 were followed postoperatively for a mean period of nine years, with 80 of them on anticoagulants. Thromboembolism is the major late problem, with 25 thromboembolic accidents noted in 25 patients (22.3%). Anticoagulation was ineffective or lacking in 72% of them. Bacterial endocarditis was noted in five cases (4.4%) and a prosthetic leak in three (2.6%). Particular problems are observed in this group of young patients. First, recurrence of rheumatic fever in nine patients with an increasing severity of aortic valvar incompetence; second, with growth the prosthesis can become small as observed in six of our patients. A reoperation was needed in 15 patients, with one requiring two reoperations. Late mortality was 21%. Optimal timing for replacement of the valve is crucial. Appropriate anticoagulation and correct prophylaxis of rheumatic fever and bacterial endocarditis is mandatory. Conservative surgery is certainly preferable to valvar replacement, but if replacement proves necessary, large prostheses should be used.

Keywords

Rheumatic mitral valvar diseasecongenital mitral diseasemitral valvar replacementpediatric cardiac surgery
Type
Original Manuscripts
Information
Cardiology in the Young , Volume 5 , Issue 3 , July 1995 , pp. 225 - 229
Copyright
Copyright © Cambridge University Press 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Caillat, M, Leca, F, Thibert, M, Tamisier, D, Abdel-Meguid, I, Vouhe, P, Neveux, JY. Remplacement valvulaire mitral dans le canal atrio-ventriculaire. Arch Mal Coeur 1990; 83: 711–715.Google Scholar
2.Benmimoun, EG, Friedli, B, Rutishauser, W, Faidutti, B. Mitral valve replacement in children: comparative study of pre and postoperative haemodynamics and left ventricular function. Br Heart J 1982; 48: 117–124.CrossRefGoogle ScholarPubMed
3.Cabrol, C, Cabrol, A, Gandjbakhch, I, Guiraudon, G, Christides, C, Mattei, MF, Gobin, F. Le remplacement valvulaire prothetique chez 1'enfant. Arch Mal Coeur 1976; 69: 169.Google Scholar
4.Attie, F, López-Soriano, F, Ovseyvitz, J, Martinez, J, Gil-Moreno, M, Buendia, A, Chávez-Domínguez, R, Richheimer, R. Late results of mitral valve replacement with the Björk-Shiley prosthesis in children under 16 years of age. J Thorac Cardiovasc Surg 1986; 91: 754–758.CrossRefGoogle ScholarPubMed
5.Gardner, TJ, Roland, JMA, Neill, CA, Donahoo, JS. Valve replacement in children, a fifteen year perspective. J Thorac Cardiovasc Surg 1982; 83: 178–185.CrossRefGoogle ScholarPubMed
6.Kadoba, K, Jonas, RA, Mayer, JE, Castañeda, AR. Mitral valve replacement in the first year of life. J Thorac Cardiovasc Surg 1990; 100: 762–768.CrossRefGoogle ScholarPubMed
7.Berry, BE, Ritter, DG, Wallace, RB, McGoon, DC, Danielson, GK. Cardiac valve replacement in children. J Thorac Cardiovasc Surg 1974; 68: 705–710.CrossRefGoogle ScholarPubMed
8.Ilbawi, MN, Idriss, FS, DeLeon, SY, Muster, AJ, Duffy, CE, Gidding, SS, Paul, MH. Valve replacement in children: guidelines for selection of prosthesis and timing of surgical intervention. Ann Thorac Surg 1987; 44: 398–403.CrossRefGoogle ScholarPubMed
9.Iyer, KS, Reddy, KS, Rao, IM, Venugopal, P, Bhatia, ML, Gopinath, N. Valve replacement in children under twenty years of age—experience with Björk-Shiley prosthesis. J Thorac Cardiovasc Surg 1984; 88: 217–224.CrossRefGoogle ScholarPubMed
10.Edmunds, LM Jr. Thrombo-embolic complications of current cardiac valvular prostheses. Ann Thorac Surg 1982; 34: 96–106.CrossRefGoogle Scholar
11.Vernant, P. Les prothèses valvulaires chez 1'enfant. Arch Mal Coeur 1976; 2: 161–164.Google Scholar
12.Zweng, TN, Bluett, MK, Mosca, R, Callow, LB, Bove, EL. Mitral valve replacement in the first 5 years of life. Ann Thorac Surg 1989; 47: 720–724.CrossRefGoogle ScholarPubMed
13.Abid, F, Abid, A, Fekih, M, Zaouali, RM, Ben Ismail, M. Aortic valve replacement in children under 16 years of age with congenital or rheumatic valvular disease. A study of 64 cases. J Cardiovasc Surg 1992; 33: 265–271.Google ScholarPubMed
14.Williams, WG, Pollock, JC, Geiss, M, Trusler, GA, Fowler, RS. Experience with aortic and mitral valve replacement in children. J Thorac Cardiovasc Surg 1981; 81: 326–333.CrossRefGoogle ScholarPubMed
15.Schaffer, MS, Clarke, DR, Campbell, DN, Madigan, CK, Wiggins, JW Jr, Wolfe, RR. The St. Jude medical cardiac valve in infants and children: role of anticoagulant therapy. J Am Coll Cardiol 1987; 9: 235–239.CrossRefGoogle ScholarPubMed
16.Bex, JP, Robinault, J, Boussa, L, Beghoul, M, Assari, R, Mertani, A, Merrad, K, Baillo, F. La chirurgie valvulaire chez 1'enfant algérien. Coeur 1980; 3: 887–890.Google Scholar
17.Milano, A, Bortolotti, U, Mazzucco, A, Guerra, F, Magni, A, Stellin, G, Gallucci, V. Mitral valve replacement with the Hancock, Björk-Shiley and Lillehei-Kaster prostheses, a comparison based on a 15 year follow-up. Eur J Cardio Thorac Surg 1989; 3: 312–320.CrossRefGoogle ScholarPubMed
18.Friedman, S, Edmunds, LH Jr, Cuaso, C. Long-term mitral valve replacement in young children: influence of somatic growth on prosthetic valve adequacy. Circulation 1978; 57: 981–986.CrossRefGoogle ScholarPubMed
19.Pass, HI, Sade, RM, Crawford, FA, Hohn, AR. Cardiac valve prostheses in children without anticoagulation. J Thorac Cardiovasc Surg 1984; 87: 832–835.CrossRefGoogle ScholarPubMed
20.Borkon, AM, Soule, L, Reitz, BA, Gott, VL, Gardner, TJ. Five year follow-up after valve replacement with the St. Jude Medical valve in infants and children. Circulation 1996; 74(Suppl I):I110–I115.Google Scholar
21.McGrath, LB, Gonzalez-Lavin, L, Eldredge, WJ, Colombi, M, Restrepo, D. Thromoboembolic and other events following valve replacement in a pediatric population treated with antiplatelet agents. Ann Thorac Surg 1987; 43: 285–287.CrossRefGoogle Scholar
22.Galloway, AC, Colvin, SB, Baumann, FG, Grossi, EA, Ribakove, GH, Harty, S, Spencer, FC. A comparison of mitral valve reconstruction with mitral valve replacement: intermediate term results. Ann Thorac Surg 1989; 47: 655–662.CrossRefGoogle ScholarPubMed
23.Pilichowski, P, Barrie, J, Latreille, R. Ecoulement à travers différents types de prothèses valvulaires thoraciques. J Chir 1980; 2: 129–134.Google Scholar
24.Sanders, SP, Levy, RJ, Freed, MD, Norwood, WI, Castañeda, AR. Use of Hancock porcine xenografts in children and adolescents. Am J Card 1980; 464: 429–438.CrossRefGoogle Scholar
25.Robbins, RC, Bowman, FO Jr, Malm, JR. Cardiac valve replacement in children: a twenty year series. Ann Thorac Surg 1988; 45: 56–61.CrossRefGoogle ScholarPubMed
26.Weinstein, GS, Mavroudis, C, Ebert, PA. Preliminary experience with aspirin for anticoagulation in children with prosthetic cardiac valves. Ann Thorac Surg 1982; 33: 549–553.CrossRefGoogle ScholarPubMed
27.Chard, RB, Cartmill, T. Thrombosed CarboMedics mitral valve prosthesis. J Thorac Cardiovasc Surg 1990; 100: 800–801.CrossRefGoogle ScholarPubMed
28.Abid, F, Mzah, N, El Euch, F, Ben Ismail, M. Valve replacement in children under 15 years with rheumatic heart disease. Pediatr Cardiol 1989: 10: 199–204.CrossRefGoogle ScholarPubMed