Mitral valve replacement in children under 3 years of age.
OBJECTIVE
This study was undertaken to review our experience of mitral valve replacement in children under 3 years of age.


METHODS
Between January 1990 and May 2004, 18 patients under 3 years of age underwent a total of 20 mitral valve replacements using a bileaflet mechanical prosthetic valve. There were 9 males and 11 females. The age at surgery ranged from 3 months to 3 (mean=1.02 +/- 0.72) years and body weight varied between 3.4 and 13.2 (mean=7.08 +/- 2.74) kg.


RESULTS
There were 4 early and 2 late deaths, and these occurred in severe cases aged less than 1 year of age. Re-replacement of mitral valve was required in 3 patients (valve thrombosis in 2 and pannus formation in 1). Orifice size of the implanted prosthesis (OS) as compared with the predicted normal size of the mitral valve (NS) was well correlated with maximum transprosthetic flow velocity estimated by Doppler echocardiography. In this study, the OS/NS>0.65 was maintained in all patients, and none required re-replacement because of prosthesis-patient mismatch.


CONCLUSIONS
Patients less than 1 year of age had significant mortality and morbidity. The results were satisfactory in the remainder (1-3 years). During this follow-up period, none required re-replacement due to somatic growth, but it will be an unavoidable problem in the future. The OS/NS, which can be checked with a regular physical examination, may serve as a guide to determine the most appropriate timing for the second surgery.
Wada
Naoki
N
Department of Cardiovascular Surgery, Sakakibara Heart Institute Japan, Research Promotion Society For Cardiovascular Diseases, Tokyo, Japan.
Takahashi
Yukihiro
Y
Ando
Makoto
M
Park
In-Sam
IS
Kikuchi
Toshio
T
D002675:Child, Preschool; D015150:Echocardiography, Doppler; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D007223:Infant; D008297:Male; D008943:Mitral Valve; D012086:Reoperation