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[Pulmonary valve replacement in children]

E Saro-Servando1, C Vazquez, S Vobecky

  • 1Service de Chirurgie Cardiovasculaire, Hôpital Sainte-Justine, Montréal, Québec, Canada.

Annales De Chirurgie
|January 1, 1996
PubMed
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Pulmonary valve replacement (PVR) in children yielded satisfactory results, with no major complications. However, small bioprostheses showed deterioration over time, indicating careful patient selection is crucial.

Area of Science:

  • Cardiology
  • Pediatric Cardiac Surgery
  • Biomaterials Science

Background:

  • Pulmonary valve replacement (PVR) is a critical procedure in pediatric cardiac surgery.
  • Congenital heart defects often necessitate PVR, with tetralogy of Fallot and absent pulmonary valve syndrome being common indications.
  • Bioprosthetic valves are frequently used, but their long-term durability in pediatric patients remains a concern.

Purpose of the Study:

  • To evaluate the outcomes of pulmonary valve replacement (PVR) in a pediatric population.
  • To assess the safety and efficacy of bioprosthetic valves and aortic homografts in children undergoing PVR.
  • To analyze the long-term performance of implanted valves and identify factors influencing outcomes.

Main Methods:

  • A retrospective review of 15 pediatric patients who underwent PVR between February 1988 and October 1994.

Related Experiment Videos

  • Analysis of patient demographics, underlying cardiac conditions, type of prosthesis implanted (14 bioprostheses, 1 aortic homograft), and perioperative management.
  • Long-term follow-up included clinical assessment (New York Heart Association class) and echocardiographic evaluation of valve function and pulmonary gradients.

    • Main Results:

    • Fifteen children with a mean age of 145.7 months underwent PVR for various complex congenital heart diseases.
    • One operative death occurred due to anaphylaxis; one late death was unrelated to surgery. All surviving patients were in NYHA Class 1 at follow-up (mean 40.7 months).
    • No hemorrhagic or thromboembolic events were observed, and no reoperations for bioprosthesis failure were needed. However, two patients with 21 mm bioprostheses developed significant pulmonary gradients (80-85 mmHg) 65-80 months post-PVR.

    Conclusions:

    • Pulmonary valve replacement in children can achieve satisfactory short-to-medium term outcomes with low complication rates.
    • Progressive deterioration of smaller bioprosthetic valves is a concern, necessitating careful consideration of prosthesis size and type.
    • PVR in children should be reserved for symptomatic individuals with severe pulmonary regurgitation due to the potential for long-term bioprosthesis failure.