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. 2000 Dec;84(6):636–642. doi: 10.1136/heart.84.6.636

Mitral valve replacement in children: mortality, morbidity, and haemodynamic status up to medium term follow up

C van Doorn 1, R Yates 1, V Tsang 1, M deLeval 1, M Elliott 1
PMCID: PMC1729513  PMID: 11083744

Abstract

OBJECTIVE—To investigate the outcome of mechanical mitral valve replacement in children after up to 11 years of follow up.
DESIGN—Retrospective analysis of case records. Operative survivors underwent echocardiographic studies to define current haemodynamic status and prosthetic valve function.
SETTING—Tertiary referral centre.
PATIENTS—All 54 children who underwent mitral valve replacement between January 1987 and December 1997.
RESULTS—30 day mortality was 20.3% and was associated with small valve size and supra-annular position. The actuarial freedom from the following events at five years (70% confidence interval (CI)) was: death, including 30 day mortality and transplantation, 68% (70% CI 62% to 75%); bleeding, 89% (70% CI 84% to 94%); non-structural valve dysfunction and reoperation, 92% (70% CI 87% to 97%). The incidence of endocarditis and thromboembolism was low and there was no structural valve failure. Event-free survival was 52% (70% CI 45% to 60%). Low weight, young age, and small valve size increased the chance of death or reoperation. On echocardiography, left ventricular dilatation and wall motion abnormalities were often observed. A high mean gradient over the prosthesis was associated with small valve size but not with length of follow up.
CONCLUSIONS—With the use of mechanical prostheses for mitral valve replacement in children, the problem of structural valve failure is no longer an issue. However, the procedure is still associated with a high complication rate, both at surgery and during follow up, and should therefore be reserved for patients in whom valve repair is not technically feasible.


Keywords: mitral valve replacement; prosthetic mitral valve; child; outcome

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Figure 1  .

Figure 1  

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Age of the patient at the time of mitral valve replacement and size and type of prosthesis inserted. Younger children generally received smaller prostheses. Empty symbols, tilting disk prosthesis; filled symbols, bileaflet prosthesis.

Figure 2  .

Figure 2  

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(A) Actuarial freedom from death or transplantation (including 30 day deaths) following mitral valve replacement; 70% confidence limits are indicated at 5 and 10 years. The numbers of patients originally at risk for the event at the time of the operation and at 5 and 10 years follow up are given in parentheses in this and all the following curves. These numbers become very small towards maximum follow up time. (B) Actuarial freedom from bleeding. (C) Actuarial freedom from non-structural valve dysfunction. (D) Event-free survival.

Figure 3  .

Figure 3  

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Echocardiographic measurement of left ventricular internal diameter according to body surface area. Reference lines indicate 95% prediction limits. (A) Measurement at end systole. (B) Measurement at end diastole. BSA, body surface area; LVEDD, left ventricular end diastolic dimension; LVESD, left ventricular end systolic dimension.

Figure 4  .

Figure 4  

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Increment in prosthetic valve size achieved in children who underwent redo mitral valve replacement.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adatia I., Moore P. M., Jonas R. A., Colan S. D., Lock J. E., Keane J. F. Clinical course and hemodynamic observations after supraannular mitral valve replacement in infants and children. J Am Coll Cardiol. 1997 Apr;29(5):1089–1094. doi: 10.1016/s0735-1097(97)00017-x. [DOI] [PubMed] [Google Scholar]
  2. Almeida R. S., Elliott M. J., Robinson P. J., Wyse R. K., Taylor J. F., Stark J., de Leval M. R. Surgery for congenital abnormalities of the mitral valve at the Hospital for Sick Children, London from 1969-1983. J Cardiovasc Surg (Torino) 1988 Jan-Feb;29(1):95–99. [PubMed] [Google Scholar]
  3. Carpentier A., Branchini B., Cour J. C., Asfaou E., Villani M., Deloche A., Relland J., D'Allaines C., Blondeau P., Piwnica A. Congenital malformations of the mitral valve in children. Pathology and surgical treatment. J Thorac Cardiovasc Surg. 1976 Dec;72(6):854–866. [PubMed] [Google Scholar]
  4. Davachi F., Moller J. H., Edwards J. E. Diseases of the mitral valve in infancy. An anatomic analysis of 55 cases. Circulation. 1971 Apr;43(4):565–579. doi: 10.1161/01.cir.43.4.565. [DOI] [PubMed] [Google Scholar]
  5. Dunn J. M. Porcine valve durability in children. Ann Thorac Surg. 1981 Oct;32(4):357–368. doi: 10.1016/s0003-4975(10)61757-2. [DOI] [PubMed] [Google Scholar]
  6. Duran C. M., Gometza B., Martin-Duran R., Saad E., al-Halees Z. Performance of 96 CarboMedics valve replacements in 75 patients less than twenty-one years of age. Ann Thorac Surg. 1994 Sep;58(3):639–645. doi: 10.1016/0003-4975(94)90720-x. [DOI] [PubMed] [Google Scholar]
  7. Edmunds L. H., Jr, Clark R. E., Cohn L. H., Grunkemeier G. L., Miller D. C., Weisel R. D. Guidelines for reporting morbidity and mortality after cardiac valvular operations. The American Association for Thoracic Surgery, Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity. Ann Thorac Surg. 1996 Sep;62(3):932–935. doi: 10.1016/s0003-4975(96)00531-0. [DOI] [PubMed] [Google Scholar]
  8. Fiore A. C., Naunheim K. S., D'Orazio S., Kaiser G. C., McBride L. R., Pennington D. G., Peigh P. S., Willman V. L., Labovitz A. J., Barner H. B. Mitral valve replacement: randomized trial of St. Jude and Medtronic-Hall prostheses. Ann Thorac Surg. 1992 Jul;54(1):68–73. doi: 10.1016/0003-4975(92)91142-v. [DOI] [PubMed] [Google Scholar]
  9. Horstkotte D., Schulte H. D., Bircks W., Strauer B. E. Lower intensity anticoagulation therapy results in lower complication rates with the St. Jude Medical prosthesis. J Thorac Cardiovasc Surg. 1994 Apr;107(4):1136–1145. [PubMed] [Google Scholar]
  10. Ibrahim M., Cleland J., O'Kane H., Gladstone D., Mullholland C., Craig B. St. Jude Medical prosthesis in children. J Thorac Cardiovasc Surg. 1994 Jul;108(1):52–56. [PubMed] [Google Scholar]
  11. Kadoba K., Jonas R. A., Mayer J. E., Castaneda A. R. Mitral valve replacement in the first year of life. J Thorac Cardiovasc Surg. 1990 Nov;100(5):762–768. [PubMed] [Google Scholar]
  12. Milano A., Vouhé P. R., Baillot-Vernant F., Donzeau-Gouge P., Trinquet F., Roux P. M., Leca F., Neveux J. Y. Late results after left-sided cardiac valve replacement in children. J Thorac Cardiovasc Surg. 1986 Aug;92(2):218–225. [PubMed] [Google Scholar]
  13. Nudelman I., Schachner A., Levy M. J. Repeated mitral valve replacement in the growing child with congenital mitral valve disease. J Thorac Cardiovasc Surg. 1980 May;79(5):765–769. [PubMed] [Google Scholar]
  14. Schaffer M. S., Clarke D. R., Campbell D. N., Madigan C. K., Wiggins J. W., Jr, Wolfe R. R. The St. Jude Medical cardiac valve in infants and children: role of anticoagulant therapy. J Am Coll Cardiol. 1987 Jan;9(1):235–239. doi: 10.1016/s0735-1097(87)80108-0. [DOI] [PubMed] [Google Scholar]
  15. Stellin G., Bortolotti U., Mazzucco A., Faggian G., Guerra F., Daliento L., Livi U., Gallucci V. Repair of congenitally malformed mitral valve in children. J Thorac Cardiovasc Surg. 1988 Mar;95(3):480–485. [PubMed] [Google Scholar]
  16. Uva M. S., Galletti L., Gayet F. L., Piot D., Serraf A., Bruniaux J., Comas J., Roussin R., Touchot A., Binet J. P. Surgery for congenital mitral valve disease in the first year of life. J Thorac Cardiovasc Surg. 1995 Jan;109(1):164–176. doi: 10.1016/S0022-5223(95)70432-9. [DOI] [PubMed] [Google Scholar]
  17. Zweng T. N., Bluett M. K., Mosca R., Callow L. B., Bove E. L. Mitral valve replacement in the first 5 years of life. Ann Thorac Surg. 1989 May;47(5):720–724. doi: 10.1016/0003-4975(89)90126-4. [DOI] [PubMed] [Google Scholar]
  18. van Doorn C., Yates R., Tunstill A., Elliott M. Quality of life in children following mitral valve replacement. Heart. 2000 Dec;84(6):643–647. doi: 10.1136/heart.84.6.643. [DOI] [PMC free article] [PubMed] [Google Scholar]

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