From February 1980 to September 1995, 31 children between 2 months and 15 years of age with mitral valve disease have undergone mitral valve replacement(MVR) at Yonsei Cardiovascular Center and complete follow-up has been obtained on 28 patients.
There
were 10 males and 18 females whose weight ranged from 4.9kg to 56kg.
Two patients died early postoperatively and the overall hospital mortality rate was 7.1%. These two were infants but there were no statistically significant difference in overall mortality among the age groups(P=0.13).
The valve related complication rate was 57.1% in children younger than 5 years of age, which showed higher complication rate compared to older patients(p<0.05).
The bioprosthetic valve have been applied in 7 patients, and its 5-year valve failure-free survival rate was 50%. No mechanical valve failure had occurred in 21 patients. In considering high re-replacement6 rate of bioprosthetic valve, mechanical
valve
is recommended despite its possibility of bleeding and thrompoempolic complications. However, the consequences of increasing body size4 and long-term interposition of a rigid prosthesis in a growing heart will require second valve replacement.
In conclusion, mitral valve replacement can be performed with satisfactory long-term survival in children, although younger mean age of the children has an important influence on early mortality and complication rate. And therefore mitral valve
replacement in children younger than 5 years of age needs special consideration.
|