Mitral valve replacement in children.

BACKGROUND AND AIMS OF THE STUDY Although repair of the mitral valve in children with or without concomitant congenital heart defects has improved significantly, it is not always achievable. The study aim was to review a 20-year experience of mitral valve replacement (MVR) in children. METHODS Since 1980, 90 patients (37 males, 53 females; mean age 8.1 years; range: 3 weeks to 18 years) have undergone a total of 102 MVR operations (12 redo-MVR, nine multiple valves, and three with common atrioventricular valve replacement). Tissue valves were used in 13 patients (14%). The etiology for valve disease was congenital in 72 patients (80%), and 34 patients had atrioventricular septal defect (AVSD). Other etiologies included rheumatic heart disease (n = 8), myxomatous disease (n = 4), endocarditis (n = 3), and Kawasaki disease, left atrial myxoma and idiopathic hypertropic subaortic stenosis (each n = 1). In total, 36 patients (40%) had a previous mitral valve repair, and 34 (38%) had concomitant repair of associated lesions. RESULTS Hospital mortality was significantly higher in children aged < 2 years (52%, 15 of 29) compared with older children (3%, 2 of 61) (p < 0.001). Fourteen hospital deaths were associated with failed repair of complex congenital heart defects, mainly AVSD under age 2 years, followed by MVR. Mean follow up was 9.3 years (range: 7 months to 21.5 years). There were four late deaths; major events included thromboemboli (n = 6), bleeding (n = 9), endocarditis (n = 1) and cardiomyopathy with orthotopic heart transplantation (n = 7). CONCLUSION MVR is a good surgical option for a nonrepairable mitral valve in children aged over 2 years. MVR following failed AVSD repair carries a high incidence of morbidity and mortality.

[1]  R G Masters,et al.  Comparative clinical outcomes with St. Jude Medical, Medtronic Hall and CarboMedics mechanical heart valves. , 2001, The Journal of heart valve disease.

[2]  V. Tsang,et al.  Mitral valve replacement in children: mortality, morbidity, and haemodynamic status up to medium term follow up , 2000, Heart.

[3]  M. Yamaguchi,et al.  Surgery for mitral valve disease in the pediatric age group. , 1999, The Journal of thoracic and cardiovascular surgery.

[4]  A. Berrebi,et al.  Reconstructive surgery in congenital mitral valve insufficiency (Carpentier's techniques): long-term results. , 1998, The Journal of thoracic and cardiovascular surgery.

[5]  J. F. Keane,et al.  Clinical course and hemodynamic observations after supraannular mitral valve replacement in infants and children. , 1997, Journal of the American College of Cardiology.

[6]  L. Galletti,et al.  Surgery for congenital mitral valve disease in the first year of life. , 1995, The Journal of thoracic and cardiovascular surgery.

[7]  A. Ardehali,et al.  Early and late results of mitral valve repair in children. , 1994, The Journal of thoracic and cardiovascular surgery.

[8]  L. Solymar,et al.  Prosthetic valves in children and adolescents. , 1991, American heart journal.

[9]  J. Mayer,et al.  Mitral valve replacement in the first year of life. , 1990, The Journal of thoracic and cardiovascular surgery.

[10]  E. Bove,et al.  Mitral valve replacement in the first 5 years of life. , 1989, The Annals of thoracic surgery.

[11]  A. Houston,et al.  Mitral valve replacement in the first three months of life. , 1984, British heart journal.

[12]  R. van Praagh,et al.  Anatomic types of congenital mitral stenosis: report of 49 autopsy cases with consideration of diagnosis and surgical implications. , 1978, The American journal of cardiology.