[The pediatrician faced with the child with a valvular prosthesis]

Among the acquired or congenital valvular dysfunctions that require conservative valvuloplastic surgical intervention or valvular replacement, the rheumatic valve disease is reported in a limited number of cases among the developed countries, while it is frequent in those with precarious socio-economic conditions. In these countries there are many cases of rheumatic valve diseases during childhood, quickly leading to serious health conditions to require valve replacement during second and third childhood. On the contrary, in the more developed countries, congenital valvular disease prevail by far. The child who underwent valve replacement, once dismissed from cardio-surgical centre, must be nursed domiciliary by his family pediatrician. This assistance consists in a strict supervision for a precocious identification of valvular prosthesis dysfunctions and possible embolic and hemorrhagic complications and in supplying anticoagulant therapy. For this purpose it is important to refer to a well equipped cardiological centre. Besides these fundamental tasks there are others - equally important - directed to preserve health: curing each pathological extracardiac event, intercurrent or recurrent; preventing, with or without compulsory vaccinations, infectious childhood's diseases; preventing especially bacterial endocarditis as the most frequent cause of prosthesis pathology. This work pays particular attention to bacterial endocarditis (prophylaxis and cure). Thromboembolism and anticoagulant therapy (with the list of coumarin drug interventions) have also been dealt. Moreover we have reported brief indications on the prevention and/or cure of diseases for which vaccination is not compulsory, such as: measles, chicken-pox, whooping-cough, typhus, influenza. Our script ends with good suggestions on nourishment and physical activity.