title: Evolving approach to aortic valve replacement in children and adolescents--a preliminary report.
abstract: BACKGROUND
  Surgical treatment methods are still controversial in children with congenital or acquired aortic valve dysfunction.
  
  
  OBJECTIVE
  To evaluate treatment results in children after mechanical or biological valve implantation.
  
  
  METHODS
  We analysed a group of 55 children after mechanical valve implantation (group A) and a group of 8 children after Freestyle biological valve implantation (group B). We evaluated in both groups: patient's age, type of valve dysfunctions, severity of heart failure symptoms, and quality of life. The parameters of physiological left ventricular (LV) remodelling were examined on the basis of echocardiographical signs of LV contractibility (%SF) and anatomical changes: LV diastolic diameter (LVDd), LV posterior wall thickness (LVPW), thickness of intra-ventricle septum (IVS) and pressure gradient between LV and aorta (LV-Ao).
  
  
  RESULTS
  There were no hospital deaths in either group. There were two late deaths in children from group A. Thromboembolic (2), nonspecific bleeding complications (2), and infections (2) occurred in group A. There were two re-operations in children after mechanical valve implantation. The early postoperative period was good in groups A and B. Furthermore, late postoperative period was good in group B. Physiological LV remodelling occurred in children in groups A and B. Quality of life was good in both groups.
  
  
  CONCLUSIONS
  Good clinical results, simplicity, repeatability and safety of surgical technique mean that mechanical valve implantation in the aortic position is still an attractive option for treatment in children and adults. However, absence of bleeding, thromboembolic and infection complications and improvement of durability mean that the Freestyle biological new generation valve could be a good option for future in children and adolescents who need aortic valve replacement.
authors.affiliation: The Children's Memorial Health Institute, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Burczyński
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Mozol
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Mirkowicz-Małek
authors.forename: Ireneusz
authors.initials: I
authors.lastname: Haponiuk
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kansy
authors.forename: Wojciech
authors.initials: W
authors.lastname: Lipiński
authors.forename: Mariusz
authors.initials: M
authors.lastname: Birbach
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pastuszko
authors.forename: Michał
authors.initials: M
authors.lastname: Kozłowski
authors.forename: Bohdan
authors.initials: B
authors.lastname: Maruszewski
mesh_terms: D000293:Adolescent; D001021:Aortic Valve / Q000637:transplantation*; D001705:Bioprosthesis; D002648:Child; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology; D020257:Ventricular Remodeling / Q000502:physiology