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Mitral valve replacement in infants and children
Insights
Mitral valve replacement using heterograft prostheses in children with severe heart failure showed improved growth and symptoms. While operative mortality was 14%, survivors experienced significant clinical benefits, suggesting suitability for pediatric patients.
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.
Abstract:
Thirteen patients, ranging in age from 10 months to 19 years (mean 7.8 years) and in weight from 6.6 to 60 kg (average 29.5 kg) underwent 14 operations for mitral valve replacement with a heterograft prosthesis between January 1, 1976 and July 1, 1979 for a variety of congenital or acquired lesions. Preoperative indications included severe refractory congestive heart failure in each patient with growth retardation, which was especially prominent in the younger patients. Operative mortality was 14% (2/14) with both deaths occurring within 48 hours of operation in patients less than 6 years of age. All surgical survivors had clinical improvement as manifested by relief of symptoms, decrease in heart size, and significant growth. Routine postoperative catheterization in five patients revealed good initial postoperative results in those studied, with one patient having a second study 20 months after operation. He was found to have had degeneration of his bovine prosthesis and had subsequent successful reoperation with a porcine prosthesis. Further long-term serial catheterizations are needed to further document the history of heterograft prosthesis in children, but they are preferred to mechanical valves became of the lack of need for long-term anticoagulants and the absence of thromboembolism complications. This series suggests that mitral valve replacement, when indicated by refractory congestive heart failure and growth retardation, can be successfully performed even in infants and small children. Surgery should not be postponed to allow for subsequent patient growth if the natural history of the disease is of progression.