Mitral valve replacement in children. Comparative study of pre- and postoperative haemodynamics and left ventricular function

The St. Jude Medical cardiac valve in infants and children: role of anticoagulant therapy

The experience at the University of Colorado with the St. Jude Medical cardiac valve was reviewed to determine the feasibility of placing this prosthesis in children and the role of anticoagulation. A St. Jude Medical cardiac valve was placed in 33 patients ranging in age from 2.5 months to 17 years. Seven patients were less than 1 year of age. Nineteen valves were placed in the aortic position in patients aged 5 months to 17 years (mean 9.5 years). Five patients had valve replacement only, 13 had concomitant aortoventriculoplasty and 1 a Manouguian procedure. Indications for anulus enlarging procedures were recurrent subaortic stenosis or inability to place an adult-sized valve in the native aortic anulus, or both. There were no early or late deaths. Fourteen valves were placed in the mitral position. They were anular positioned in 6 patients aged 6 months to 16 years and supraanular positioned in 8 patients aged 2.5 months to 2 years. There were no deaths with the anular positioned replacements and seven deaths (two early and five late) with the supraanular positioned replacements. Four of the five late deaths were associated with marked pre- and postoperative left ventricular dysfunction. The follow-up time was 784 patient-months in 31 long-term survivors. Anticoagulation was achieved with warfarin, usually in combination with sulfinpyrazone, dipyridamole or aspirin. There were four episodes of thromboembolism, three occurring in patients with suboptimal anticoagulation, and one in a patient lost to follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Mitral valve replacement in the neonate: a report of two cases

Mitral valve replacement was performed in two critically ill neonates with severe mitral stenosis and regurgitation. Both patients had coexisting severe aortic stenosis previously treated by transventricular aortic valve dilatation. Preoperative echocardiography showed a mitral annulus measuring between 11 and 12 mm in diameter--too small for any of the commercially available free-standing valve prostheses. Accordingly, the porcine valve from a commercially available 12-mm external-valved conduit was removed and sutured into position. The function of the valve was satisfactory in both cases and cardiopulmonary bypass was discontinued easily with a good cardiac output established in both. Both patients died--one at 20 h and one 36 h after surgery. In each case, the immediate cause of death was acute bleeding secondary to preexisting hepatic failure and depletion of coagulation factors. At autopsy, both prostheses had been correctly placed and were competent. Left ventricular outflow tract obstruction secondary to strut imposition was not evident. Both patients were very ill preoperatively. Although neither patient survived mitral valve replacement, we were encouraged by the relative hemodynamic improvement in the immediate postoperative period. We believe that prosthetic valve replacement could become a viable therapy for the neonate with severe mitral valve abnormalities.