Mitral valve replacement in infants and children

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Biomaterials in Medicine

Background:

• Congenital and acquired heart lesions in children often lead to severe refractory congestive heart failure and growth retardation.
• Mitral valve replacement is a critical intervention for pediatric patients with advanced cardiac disease.
• Heterograft prostheses offer an alternative to mechanical valves, avoiding the need for long-term anticoagulation.

Purpose of the Study:

• To evaluate the efficacy and outcomes of mitral valve replacement with heterograft prostheses in pediatric patients.
• To assess the impact of this procedure on clinical improvement, growth, and survival rates in young patients.
• To compare heterograft prostheses with mechanical valves in the pediatric population.

Main Methods:

• Retrospective analysis of 14 mitral valve replacement operations using heterograft prostheses in 13 pediatric patients (10 months to 19 years).
• Preoperative assessment included evaluation of congestive heart failure and growth retardation.
• Postoperative follow-up included clinical assessment and routine catheterization in select patients.

Main Results:

• Operative mortality was 14% (2/14), with deaths in patients under 6 years old.
• All surgical survivors demonstrated significant clinical improvement, including symptom relief, decreased heart size, and enhanced growth.
• Postoperative catheterization revealed good initial results; one patient experienced prosthesis degeneration requiring reoperation.

Conclusions:

• Mitral valve replacement with heterograft prostheses can be successfully performed in infants and small children with refractory congestive heart failure and growth retardation.
• Heterograft prostheses are preferred over mechanical valves in children due to the absence of thromboembolism complications and the lack of need for anticoagulation.
• Early surgical intervention is recommended for pediatric patients with progressive heart disease, rather than postponing surgery for growth.