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Valve replacement for children: report of two cases
T Takahashi1, Y Morishita, S Ishikawa
1Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan.
Insights
This study details two pediatric valve replacement cases: one for aortic regurgitation due to endocarditis and another for congenital mitral stenosis. Both patients achieved positive outcomes following prosthetic valve surgery, highlighting the importance of valve selection and follow-up.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Cardiovascular Medicine
Background:
- Infective endocarditis can lead to severe aortic regurgitation and fistulas.
- Congenital mitral stenosis, particularly commissural fusion type, poses significant challenges in pediatric patients.
- Severe pulmonary hypertension is a critical complication of mitral stenosis.
Observation:
- A 10-year-old boy with infective endocarditis underwent aortic valve replacement with a Björk-Shiley prosthesis after annular defect repair.
- A 3-year-old girl with congenital mitral stenosis required mitral valve replacement with a CarboMedicus bileaflet valve after initial commissurotomy failure.
- Both pediatric patients experienced successful surgical outcomes with prosthetic valve implantation.
Findings:
- Successful aortic valve replacement in a pediatric patient with endocarditis and annular defect.
- Effective mitral valve replacement in a pediatric patient with congenital mitral stenosis and pulmonary hypertension.
- Prosthetic valve selection and size are crucial for optimal hemodynamic function and patient outcomes.
Implications:
- This study underscores the efficacy of prosthetic valve replacement in managing complex pediatric cardiac conditions.
- Optimal prosthetic valve selection, considering type and size, is critical for maximizing orifice area and improving long-term results.
- Close postoperative monitoring is essential for patients undergoing pediatric valve replacement surgery.
Abstract:
The authors report on two children who underwent valve replacement. Case 1: A 10-year-old boy with high fever and severe heart failure was diagnosed as having aortic regurgitation and left ventriculo-right atrial fistula caused by active infective endocarditis. An aortic annular defect was repaired by a pericardial patch to enlarge the aortic annulus followed by aortic valve replacement with a 17-mm Björk-Shiley prosthetic valve. He is doing well 2 years after surgery. Case 2: A 3-year-old girl was diagnosed as having congenital mitral stenosis with severe pulmonary hypertension. Mitral valve stenosis was a commissural fusion type according to the Carpentier's classification. An open mitral commissurotomy was attempted initially, resulting in severe mitral regurgitation. Then, the mitral valve was replaced with a 16-mm CarboMedicus bileaflet valve. Her postoperative course was uneventful and residual pulmonary hypertension decreased gradually. The selection of prosthetic valves is important in its type and size in order to obtain as large an orifice as possible. Careful postoperative follow-up is mandatory.