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[Outcome more than 10 years later of mechanical mitral valve prostheses in children]
M Ben Ismail1, N Kafsi, S Trabelsi
1Hôpital la Rabta, Tunis, Tunisie.
Insights
This study analyzed long-term outcomes for 51 children who received mitral valve replacement for rheumatic heart disease. Complications included thromboembolism, prosthesis stenosis, and aortic valve issues, with irregular anticoagulation increasing risks.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Rheumatology
Context:
- Rheumatic heart disease (RHD) is a significant cause of acquired heart disease in children and adolescents globally.
- Mitral valve disease, often a sequela of RHD, necessitates surgical intervention, including valve replacement.
- The Starr Edwards 6120 mechanical prosthesis was frequently used in pediatric mitral valve replacement during the study period.
Purpose:
- To evaluate the long-term outcomes and complications of mitral valve replacement in children with rheumatic heart disease.
- To assess the incidence and nature of late mortality and morbidity following mechanical mitral valve implantation.
- To investigate the impact of anticoagulation therapy on thromboembolic events in this pediatric population.
Summary:
- Fifty-one children (8-15 years) underwent mitral valve replacement (1966-1975) using Starr Edwards 6120 prostheses for RHD.
- Late mortality was 20%, with causes including valve thrombosis, aortic regurgitation, and ventricular dysfunction.
- Long-term survivors (36 patients) experienced thromboembolic events (higher with irregular anticoagulation), prosthesis stenosis due to periannular fibrosis, and aortic valve lesions requiring reoperation.
Impact:
- This study highlights the significant long-term risks associated with mechanical mitral valve replacement in children with RHD.
- Findings underscore the importance of consistent anticoagulation management to mitigate thromboembolic complications.
- Understanding these late complications is crucial for optimizing patient management and surgical decision-making in pediatric valvular heart disease.
Abstract:
Between 1966 and 1975, fifty-one children aged from 8 to 15 years underwent mitral valve replacement for mitral valve disease of rheumatismal origin. The mechanical prosthesis was a Starr Edwards 6120 N degrees 2 valve in 48 of the children. Late mortality was 20 p. 100; death was due to valve thrombosis in 3 cases, aortic valve regurgitation in 2 cases and left ventricular dysfunction in 2 cases; it was of unknown origin in 3 cases. Four patients were lost sight of, and 36 have survived up to now with a mean follow-up period of 13 years. The life of these 36 patients has been marked by three types of complication. The first complication was thromboembolic accidents which occurred in 10 patients, were virtually always isolated and regressed completely. The incidence of these accidents was highest in patients treated with antivitamin K irregularly. In 23 patients who did not receive antivitamin K the incidence was only 2.27 thromboembolic accidents per 100 patient-years. The second complication, which affected only 4 patients, was functional stenosis of the prosthesis; it developed very late and was always due to periannular fibrosis either isolated or associated with remodelling of the mitral valve left in situ. The third complication was the development, with or without patent rheumatismal activity, of a lesion of the aortic orifice which required reoperation in 5 cases.(ABSTRACT TRUNCATED AT 250 WORDS)