Aortic valve replacement in preteenage children.
During the last 15 years, 26 children who ranged from 4 to 12 years old underwent subcoronary aortic valve replacement (AVR) at the Texas Heart Institute. The valve lesions resulted from congenital heart disease in 20 patients, 15 of whom had had a previous operation including 13 aortic valve procedures. Cystic medial necrosis necessitated AVR in 5 patients, all of whom had physical findings of Marfan's syndrome. One patient had rheumatic heart disease and required double-valve (aortic and mitral) replacement. Six different types of prosthesis were used: the Smeloff-Cutter, Starr-Edwards, Cooley-Cutter, Hancock porcine, Ionescu-Shiley, and Bjork-Shiley. The first patient in the series was the only early death (3.8%). Log-term follow-up data ranging from 1 month to 10 years were available on 20 patients. Three late deaths occurred (11.5%). All survivors are doing well and have good exercise tolerance. These data suggest that AVR performed in childhood is a safe, durable, and well-tolerated form of therapy. Later replacement, if necessary, can be accomplished with larger-sized prostheses. Our present choice is the Ionescu-Shiley bovine xenograft because of its superior hemodynamic characteristics and low incidence of embolic complications.
D000367:Age Factors; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011183:Postoperative Complications