Immediate and long term evolution of valve replacement in children less than 12 years old

Abstract

Atik et al Valve replacement in childrem less than 12 years old Arq Bras Cardiol volume 73, (nº 5), 1999 Immediate and Long Term Evolution of Valve Replacement in Children Less than 12 Years Old Original ArticleThe high prevalence of rheumatic fever in infants and adolescents draws attention to the peculiarities of the disease, which frequently causes serious valves dysfunction often in association with conditions of rheumatic activity of the cardiac muscle. Due to their important hemodynamic repercussions, such conditions may at times require urgent surgical intervention 1 .Conservative surgical procedures, a primary approach to these cases, are often not possible due to pathological alterations present in cardiac valves. On the other hand, valve replacement in infants and adolescents has its own set of difficulties, in particular, which prostheses types and size to use.The aim of this work is to present the immediate and long-term experience of our valve replacement service with children under 12 years of age, with the aim of identifying the ideal prosthesis for use at this age group. MethodsForty-four patients under 12 years of age who underwent to valve replacement at the Heart Institute, Hospital of Clinics, University of São Paulo Medical School between January 1986 and December 1992, were retrospectively analyzed.Twenty-three (52.3%) were males between 2 and 12 years of age (average age 10 years). Their valve diseases were of rheumatic in origin in 40 (91%), degenerative in 2 (4.5%) and congenital in 2 (4.5%) of the cases. Twenty (45.5%) of the patients were in preoperative NYHA functional class IV, 19 (43.2%) were in functional class III and 5 (11.3%) were in functional class II of the NYHA scale. Nineteen (43.2%) had emergency operations, 6 (13.6%) had chronic atrial fibrillation and 13 (29.5%) showed laboratory and scintigraphic evidence of rheumatic activity.Valve replacements were performed in the mitral position in 30 patients (68.2%), in the aortic position in 8 (18.2%) and in the tricuspid position in one (2.3%). Five (11.3%) patients were underwent double mitral and aortic valve replacement.

Clinical Profile and Management in Children with Rheumatic Heart Disease in a Tertiary Cardiac Care Center of Nepal

“…20 However, valvular surgery in pediatric population has its own difficulties regarding the procedure, the size of the valve and immediate postoperative complications. 21 Further there is an additional burden of lifelong oral anticoagulants required after valvular replacement therapy along with the complication of valve thrombosis and systemic embolic disasters. 22 However, 40 children of less than 15 years of age had had to undergo valvular repair/replacement surgery as their symptoms despite adequate and aggressive medical therapy.…”

Prevalence of Streptococcus pyogenes as an oropharynx colonizer in children attending daycare: a comparative study of different regions in Brazil

“…About 30% to 40% of acute pharyngotonsillitis are of streptococci etiology 4 , 5 , 6 , and the importance of this fact is due to the possibility of late non-suppurative complications caused by this pathogenic agent, such as for example, acute diffuse glomerulonephritis and rheumatic fever, which represents 90% of surgery indications for heart valve replacement in children in Brasil. 7 …”

Prevalência de Streptococcus pyogenes em orofaringe de crianças que freqüentam creches: estudo comparativo entre diferentes regiões do país

“…About 30% to 40% of acute pharyngotonsillitis are of streptococci etiology [4][5][6] , and the importance of this fact is due to the possibility of late non-suppurative complications caused by this pathogenic agent, such as for example, acute diffuse glomerulonephritis and rheumatic fever, which represents 90% of surgery indications for heart valve replacement in children in Brasil. 7 Besides, specially on the pediatric population, acute tonsillitis represents a large source of social inconveniences, such as missing days of school, the need to use antimicrobial drugs repeatedly, and the potential risk of suppurative complications. 8 Most studies have focused in searching alterations in the oropharynx flora of children with persistent tonsillitis.…”