[Valve replacement in children: results and long-term follow-up in 171 operated patients]

171 children aged 2-17 years underwent cardiac valve replacement between 1969 and December 1979. Valve lesions were of rheumatic origin in 160 and congenital in 11 cases. Single valve replacement of the mitral valve was performed in 116 cases, of the aortic valve in 18 cases and of the tricuspid valve once. Double valve replacement was done in 33 and triple valve replacement in 2 cases. Starr Edwards prostheses were used in most instances. Operative mortality was 5.9% and late death occurred in 8.7%. The follow-up period ranged from 1-9 years with a mean of 3.6 years. The majority of children have returned to a normal lifestyle and are symptom-free. Only 10% remain digitalized. As in adults, the most frequent complications were thromboembolic. 14 children (11%) had either an embolus or a valve thrombosis with a frequently of 3 per hundred patient-years. Other complications such as endocarditis or paravalvular leak were infrequent, and in most cases treatment was successful. Because of the markedly dilated hearts before operation it was possible in most children to use an adult size prosthesis, especially in the mitral position. Only a few children below 5 years of age received small mitral valve prostheses; they may need to be replaced ultimately by larger ones. Introduction of an embolus-free valve prosthesis for children would be a major advance. Unfortunately, porcine xenografts with their low embolic risk are not suitable for children as they often undergo rapid calcification.