Prosthetic valve replacement in adolescents with rheumatic heart disease.
To assess long-term survival and anticoagulant-related complications after mechanical valve replacement in adolescents with rheumatic heart disease, 88 patients aged <or= 18 years were prospectively followed up for 10 years (404.2 patient-years). There were 58 (65.9%) boys and 30 (34.1%) girls, with a mean age of 15.4 +/- 2.1 years. Mitral regurgitation was detected in 39 (44.3%) patients, and both mitral and aortic regurgitation in 15 (17%). Ball valves were inserted in 52 (59.1%) patients, bileaflet valves in 31 (35.2%), and single-disc valves in 5 (5.7%). There were 4 (4.5%) hospital deaths and 11 late deaths. Patient survival at 30 days, 3 months, 1, 5, and 10 years was 95.5%, 93.2%, 87.5%, 82.9%, and 82.9%, respectively. Mechanical valve thrombosis occurred in 4 patients; it was fatal in 3 of them. Three patients died from stroke. Severe hemorrhage required hospital admission in 4 (4.5%) patients. Mechanical valve replacement in adolescents, with careful follow-up and anticoagulation, has acceptable long-term results.
Department of Cardiac Surgery, Punjab Institute of Cardiology, Ghaus-ul-Azam Road, Lahore, Pakistan. rajapakhtar@gmail.com
Raja P
RP
Akhtar
Abdul R
AR
Abid
Hasnain
H
Zafar
Saqib S
SS
Sheikh
Masud A
MA
Cheema
Jawad S
JS
Khan
D000293:Adolescent; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D006470:Hemorrhage / Q000139:chemically induced; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011446:Prospective Studies; D011474:Prosthesis Design; D012214:Rheumatic Heart Disease / Q000401:mortality / Q000601:surgery*; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D013927:Thrombosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants