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[Valve replacement in children]
1Department of Cardiovascular Surgery, General Hospital of Shenyang Militaly Command, People's Liberation Army.
Insights
Mechanical valve replacement in children requires larger valve types and modified suture techniques for small rings. Low-concentration anticoagulation therapy is safe and effective post-surgery.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomedical Engineering
Context:
- Pediatric heart valve disease necessitates surgical intervention.
- Mechanical valves offer durability but pose challenges in pediatric patients.
- Congenital heart defects are frequently associated with valve disease in children.
Purpose:
- To evaluate the outcomes of mechanical valve replacement in pediatric patients.
- To identify optimal valve selection and surgical techniques for children.
- To assess the safety and efficacy of anticoagulation strategies.
Summary:
- Twenty-seven children (aged 2-14 years) underwent valve replacement (mitral, tricuspid, aortic).
- Over half had associated cardiac malformations; most presented in NYHA functional class III/IV.
- Hospital mortality was 11.1%, late mortality 16.6%, with 2 reoperations. Larger mechanical valves and modified suture techniques were recommended. Low-concentration anticoagulation proved safe.
Impact:
- Establishes guidelines for mechanical valve selection in pediatric patients.
- Highlights the importance of tailored surgical approaches for pediatric valve replacement.
- Supports the use of low-concentration anticoagulation for improved long-term outcomes in children.
Abstract:
We report 27 children aged 2-14 years underwent valve replacement. Twelve patients underwent mitral valve replacement, 11 tricuspid valve replacement, and 4 aortic valve replacement. Of them, 16(59.3%) were associated with cardiac malformation, 23 were in NYHA functional class III and IV in preoperation. 13 patients required additional procedures. There were 3 hospital deaths (11.1%), 4 late deaths (16.6%), and 2 reoperation. Our experiment suggested that the greater type of mechanical valve be essential for valve replacement in children, but suture technique be modified for the children with small valvular ring. After replacement of mechanical valve, low concentration anticoagulation therapy is considered as a safe and reliable method.