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Homograft replacement of mitral valve in children
M D Plunkett1, D J Schneider, J J Shah
1Department of Pediatrics, University of Illinois College of Medicine and Children's Hospital of Illinois at St Francis Medical Center, Peoria, USA. plunk@ilcardiac.com
Insights
Mitral valve homografts show promising early results in children needing valve replacement. These homografts offer advantages over prosthetic valves, avoiding anticoagulation complications.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Valvular Heart Disease
Background:
- Mitral valve homografts have shown success in adults.
- This study evaluates early outcomes in children with complex cardiac histories.
Observation:
- Four children (ages 5-15) underwent mitral valve replacement using cryopreserved homografts.
- All patients had pre-existing conditions including atrioventricular septal defects, previous prosthetic valves, or rheumatic heart disease.
- Preoperative echocardiography indicated moderate to severe mitral regurgitation, stenosis, or both.
Findings:
- Successful mitral valve replacement was achieved in all four pediatric patients.
- Homografts demonstrated good function with normal hemodynamics on echocardiographic follow-up.
- No patients required warfarin, indicating avoidance of anticoagulation therapy.
Implications:
- Mitral valve homografts are a viable alternative to prosthetic valves in pediatric patients.
- This approach may reduce complications related to thrombosis and anticoagulation in children.
- Homograft mitral valve replacement is technically feasible for complex pediatric congenital and acquired heart conditions.
Background:
Recent reports have demonstrated successful early outcomes using mitral valve homografts in adults. We report our early results after homograft mitral valve replacement in 4 children with previous atrioventricular septal defects, previous placement of a prosthetic valve, and rheumatic valvular disease.
Methods:
Between May 1996 and June 1997, 4 children (ages 5, 11, 13, and 15 years) underwent mitral valve replacement with cryopreserved mitral valve homografts at our institution. Preoperative echocardiography confirmed moderately severe to severe mitral regurgitation, stenosis, or both in all 4 patients.
Results:
Successful homograft valve replacement was achieved in all 4 patients. Based on symptoms, physical examinations, and echocardiographic follow-up, all four homograft mitral valves are functioning well with normal hemodynamics. None of these patients are receiving warfarin. Follow-up has been limited to 10 months.
Conclusions:
In children requiring mitral valve replacement, the use of mitral valve homografts offers advantages over prosthetic valves, such as the avoidance of complications associated with thrombosis and anticoagulation. Homograft mitral valve replacement is technically feasible in children with congenital and rheumatic heart disease and previous prosthetic valves.