title: Immediate and long term evolution of valve replacement in children less than 12 years old.
abstract: OBJECTIVE
  The aim of this work was the follow-up and evaluation of valve replacement in children under 12 years of age.
  
  
  METHODS
  Forty-four children less than 12 years old were underwent valve replacement at INCOR-HCFMUSP between January 1986 and December 1992. Forty (91%) were rheumatic, 39 (88.7%) were in functional classes II or IV, 19 (43.2%) were operated upon on an emergency basis, and 6 (13.6%) had atrial fibrillation. Biological prostheses (BP) were employed in 26 patients (59.1%), and mechanical prostheses (MP) in 18 (40.9%). Mitral valves were replaced in 30 (68.7%), aortic valves in 8 (18.2%), a tricuspid valve in 1 (2.3%), and double (aortic and mitral) valves in 5 (11.4) of the patients.
  
  
  RESULTS
  Hospital mortality was of 4.5% (2 cases). The mean follow-up period was 5.8 years. Re-operations occurred in 63.3% of the patients with BP and in 12.5% of those with MP (p=0.002). Infectious endocarditis was present in 26.3% of the BP, but in none of the cases of MP (p=0.049). Thrombosis occurred in 2 (12.5%) and hemorrhage in one (6.5%) of the patients with a MP. Delayed mortality occurred in 5 (11.9%) of the patients over a mean period of 2.6 years; four had had BP and one had a MP (NS). Actuarial survival and re-operation-free curves after 10 years were respectively, 82.5+/-7.7 (SD)% and 20.6+/-15.9%.
  
  
  CONCLUSIONS
  Patients with MP required fewer re-operation, had less infectious endocarditis and lower late mortality rates compared with patients with bioprostheses. The former, therefore, appear to be the best valve replacement for pediatric patients.
authors.affiliation: Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: F A
authors.initials: FA
authors.lastname: Atik
authors.forename: A R
authors.initials: AR
authors.lastname: Dias
authors.forename: P M
authors.initials: PM
authors.lastname: Pomerantzeff
authors.forename: M
authors.initials: M
authors.lastname: Barbero-Marcial
authors.forename: N A
authors.initials: NA
authors.lastname: Stolf
authors.forename: A D
authors.initials: AD
authors.lastname: Jatene
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery; D001705:Bioprosthesis; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D012213:Rheumatic Fever / Q000150:complications; D016896:Treatment Outcome