Mitral valve replacement in children with rheumatic heart disease.

Attié, Fause; Kuri, J; Zanoniani, C; Rentería, V. G.; Buendı́a, Alfonso; Ovseyevitz, J; López-Soriano, F; Garcia-Cornejo, M; Martínez-Ríos, Marco Antonio

doi:10.1161/01.cir.64.4.812

Cited by 28 publications

(5 citation statements)

References 27 publications

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“…Clinical improvement after surgery is evident. 23 The functional class before and six months after surgery for a group of 68 consecutive young survivors of all types of procedures for rheumatic valve disease is shown in Figure 2. Before surgery, 70.6% of patients were in functional classes III and IV.…”

Section: Results Of Surgical Treatmentmentioning

confidence: 99%

Surgery for rheumatic lesions of the cardiac valves in the young

et al. 1992

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SummaryAlthough declining in the so-called “first world,” surgery for rheumatic valvar lesions in patients less than 16 years of age is still a challenging problem in lesser developed countries. From 1970 to 1990, we operated upon and followed-up 136 children (less than 16 years) with different valvar lesions, performing various surgical procedures. The mitral valve was most frequently affected (52.9%) followed by multiple valvar disease (39.7%) and aortic (7.3%) involvement. The operations performed were valvoplasties (67), valvar replacement (49), and combined procedures (20). Hospital mortality for the overall group was 10.2%. There were 71 reinterventions in the follow-up of 20 years. Actuarial survival was 60.3% including hospital mortality. The event-free actuarial survival showed that 91% had at least one major event which required reoperation or hospital treatment, or else invasive cardiac procedures. We conclude that rheumatic valvar disease is still a challenging problem in our country, and that the severity of the illness is directly related to the younger age patients. In spite of reasonable long-term survival, very few patients had an uneventful follow-up after surgery.

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Section: Results Of Surgical Treatmentmentioning

confidence: 99%

Surgery for rheumatic lesions of the cardiac valves in the young

et al. 1992

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“…Mitral valve disease, in particular, is present in all cases who have sequels of the rheumatic process. Replacement 9 "" or reconstruction 12 of the valve is often necessary in children under 16 years of age. In this young population, however, the differential diagnosis between congenital and rheumatic lesions is mandatory.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary valvar involvement in rheumatic heart disease—a study of 100 post-mortem cases

et al. 1992

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SummaryWe reviewed 100 postmortems of patients with pulmonary valvar involvement due to rheumatic heart disease. The patients were divided in two groups: the first group included 59 cases with acute rheumatic lesions of the pulmonary valve. At the time of death, the mean age in this group was 18.4 ± 9.7 years. The second group was formed by 41 patients with chronic rheumatic lesions of the pulmonary valve whose mean age at the time of death was 25± 16.5 years. The percentage of patients who died before the age of25 years was greater in the group with acute as opposed to chronic lesions (p=O.0003). The mean age of the first attack in those with acute lesions was 11.7±7.8 years, as compare to 13.8 ± 5.3 years in those with chronic lesions. All patients but one had at least one attack of the acute rheumatic process. There was no significant difference between the groups regarding the number of acute processes. The length of the acute rheumatic process was similar in both groups. Fifty-five cases having acute lesions, and 38 of those with chronic lesions suffered involvement of all cardiac valves. Three valves were affected in two hearts, while only one heart had two affected valves. Fifteen cases had an associated congenital defect of the pulmonary valve, and we found a significantly greater incidence of rheumatic pulmonary disease in the group with co-existing congenital lesions of the valve (p.O.00001). Three patients undergoing catheterization (21.4%) showed normal, or near normal, pulmonary arterial systolic pressure. Rheumatic damage to the pulmonary valve, therefore, exists in association with plurivalvar rheumatic disease. A congenital lesion of the pulmonary valve predisposes to its involvement in the rheumatic process.

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“…The incidence of reported complications has varied considerably. A high incidence of thromboembolic events occurring after valve replacement in children has been reported by Sade and colleagues [9], although other workers have reported a fairly low incidence of this complication, particularly those researchers using Starr valves [3,4,8]. In 1979 Sade and colleagues [9] reviewed the literature concerning these complications and recorded a 10% incidence of hemorrhagic problems following anticoagulant therapy.…”

Section: Choice Of Valvementioning

confidence: 98%

“…During the next 3 years more descriptions of calcific valve failure appeared. These initially related only to the porcine prosthesis [3,6,12,[15][16][17][18][19][20], but more recently there have been a number of reports of calcific degeneration and valve failure occurring in bovine pericardial valves [21,22]. The change in pattern of valve usage seen in Fig.…”

Section: Choice Of Valvementioning

confidence: 99%

“…Pathologically, there are 2 main indications for valve replacement: congenital defects and acquired rheumatic disease. There is a distinct demographic difference in distribution of these diagnoses, with rheumatic disease remaining the main indication for valve replacement in many areas of the third world [2][3][4]. In the western world, however, congenital abnormalities form the major part of the workload in valve replacement for children.…”

Section: Indications For Valve Replacementmentioning

confidence: 99%

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Valve replacement in children

Elliott

Leval

1985

World j. surg.

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With increasing experience in the surgical management of children with congenital heart disease has come an increasing use of prosthetic valves. They have been employed in a wide variety of conditions ranging from simple congenital stenosis or incompetence to an essential part of repair of more complex disorders. As in adult cardiac surgery, there has been considerable debate over the exact prostheses that should be used in individual circumstances. As we point out in this article, experience has varied both geographically and with time. Our own experience at Great Ormond Street, for example, has been of initial satisfaction with results of mechanical valves followed by enthusiasm for, sequentially, the Hancock and the Ionescu prostheses. Now we have turned full circle and predominantly use mechanical valves, primarily owing to the extraordinary incidence of premature, degenerative calcification of bioprosthetic valves in children. The exact rates of degeneration of these valves are variable; thus it is difficult to relate prosthesis survival to the growth rate of the child. The experience with homograft valve replacements is encouraging, since they do not seem to degenerate so rapidly. Valve replacement in children carries a high risk. The younger the child, the higher the risk, with mitral valve replacement being the most dangerous procedure of all. We conclude that valve replacement in children is a procedure that should not be taken lightly and for which, at present, mechanical valves offer the best prognosis, despite the small risk of anticoagulation.

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Mitral valve replacement in children with rheumatic heart disease.

Cited by 28 publications

References 27 publications

Surgery for rheumatic lesions of the cardiac valves in the young

Surgery for rheumatic lesions of the cardiac valves in the young

Pulmonary valvar involvement in rheumatic heart disease—a study of 100 post-mortem cases

Valve replacement in children

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