Medium-term follow-up of mechanical valves inserted in children.
OBJECTIVE
We reviewed our experience with mechanical valves inserted between 1988 and 2002 in children aged 15 years or younger.


METHODS
Hospital files were extracted retrospectively. Follow-up was completed by March 2005.


RESULTS
Of 41 patients, we inserted a valve in atrioventricular position in 27 children, having a median age of 3.1 years, ranging from 0.4 to 14.5 years, and in aortic position in the remaining 14, having a median age of 13.5 years, and a range from 7.0 to 14.9 years. For the valves inserted in atrioventricular position, the underlying disease was congenital in 23, rheumatic in two, post-endocarditic in one, and Marfan's syndrome in one. Mean follow-up was 7.7 years, with standard deviation of 5.3, giving a total follow-up of 209 patient years. Mortality at 30 days was 7%, and survival was 73% at up to 16 years follow-up. Events related to anticoagulation were seen in 3 patients, corresponding to 1.4% per patient year. In 6 patients (22%), heart block ensued which required implantation of a pacemaker treatment, and 5 patients (19%) had reoperations. For the implantations in aortic position, the underlying disease was congenital in 13, stenosis in 10 and insufficiency in three, and post-endocarditis in one. Mean follow-up was 6.8 years, with standard deviation of 4.6, giving a total of 95 patient years. We lost one patient within 30 days (7.7% mortality), and survival was 77% at up to 13 years follow-up. There were no incidents of thrombosis, nor events related to anticoagulation, but one patient (7%) needed insertion of a pacemaker due to a perioperative heart block, and one (7%) required new valvar replacement.


CONCLUSIONS
Although preferably avoided, mechanical valves can be implanted in children with an acceptable mortality and morbidity, and good long-term results.
Larsen
Signe Holm
SH
Department of Thoracic and Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark. signe_holm_larsen@hotmail.com
Houlind
Kim
K
Hansen
Ole Kromann
OK
Hjortholm
Kirsten
K
Emmertsen
Kristian
K
Hjortdal
Vibeke
V
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors