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Repeated mitral valve replacement in the growing child with congenital mitral valve disease
Insights
Second mitral valve replacements were successful in two pediatric patients, aged 5 and 9. Larger prostheses were implanted as children
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Mitral valve replacement in pediatric patients presents unique challenges due to growth and development.
- Previous studies have reported on single mitral valve replacements in children.
- Long-term outcomes and the feasibility of repeat valve interventions in pediatric populations require further investigation.
Observation:
- Two children, aged 5 and 9 years, underwent successful second-replacement of their mitral valve prostheses.
- The first patient had a parachute mitral valve deformity corrected at 10 months with a Starr-Edwards prosthesis.
- The second patient, with Marfan's syndrome, had an initial mitral valve replacement at 3 years with a Starr-Edwards prosthesis.
Findings:
- In both cases, the left ventricle size increased between the initial and second valve replacement surgeries.
- The mitral annulus accommodated larger Björk-Shiley prostheses during the second replacement, indicating no size limitation.
- Excellent clinical results were observed during follow-up periods of 1 and 6 years post-second replacement.
Implications:
- Repeat mitral valve replacement is a viable option for pediatric patients experiencing prosthesis failure or outgrowing initial implants.
- The findings suggest that pediatric patients' cardiac anatomy can adapt to accommodate larger valve prostheses in subsequent surgeries.
- This study contributes to understanding the long-term management of pediatric valvular heart disease and prosthesis selection.
Abstract:
The successful second-replacement of mitral valve prostheses in two children, age 5 and 9 years, is reported. In one, a parachute mitral valve deformity was first corrected at the age of 10 months by the small-size 00 Starr-Edwards prosthesis. The second child had mitral valve disease caused by Marfan's syndrome 1; the valve was initially replaced at the age of 3 years by a size 0 Starr-Edwards prosthesis. For both patients, in the period between the two interventions, the left ventricle had grown in size and the mitral anulus was not a limiting factor in the insertion of a larger prosthesis of the Björk-Shiley type. Follow-up periods of 1 and 6 years, respectively, confirm excellent clinical results. Problems concerning valve replacements in pediatric patients are discussed.