Outcomes and associated risk factors for mitral valve replacement in children☆

Abstract

Mortality and mitral reoperation are common after MVR in children and outcomes can be predicted based on patient's age, prosthesis size, and other associated factors. Some modifiable factors such as avoiding oversized prostheses may improve outcomes especially in the smallest children.

Echocardiographic assessment of prosthetic mitral valves in children

“…First, the number of patients included in the current study was too small to be conclusive. Further 1,15,20 and the ratio of PMV size to BSA-predicted mitral valve size. 20 As opposed to the nominal orifice area of the PMV, which varies in different products, the PMV size is easily obtained from medical charts in echocardiography laboratories.…”

“…PMV obstruction due to thrombosis is one of the most serious long‐term complications in patients with PMVs. In a retrospective study of 307 children who had undergone mitral valve replacement, 13 experienced thromboembolic complications, which resulted in a thromboembolism‐free survival rate of 92% 15 years post surgery . As two‐dimensional echocardiography sometimes fails to visualize leaflet motion of the PMV due to acoustic shadowing, assessment of the Doppler‐derived hemodynamic parameters is important in the detection of PMV obstruction …”

“…We adopted the PMV size z‐score based on BSA as an indicator of the relationship between PMV size and body size. Previous reports used various indices of relative PMV size including the nominal orifice area of the PMV indexed to BSA, PMV size indexed to body weight, and the ratio of PMV size to BSA‐predicted mitral valve size . As opposed to the nominal orifice area of the PMV, which varies in different products, the PMV size is easily obtained from medical charts in echocardiography laboratories.…”

Reemplazo valvular mitral en edad pediátrica

“…Otro grupo de pacientes candidatos para colocación de una válvula biológica son los que no tienen acceso a una monitorización adecuada de la anticoagulación. 7,9,12,13 En nuestra serie colocamos una válvula biológica en una paciente de 18 años con retraso moderado en el neurodesarrollo, de escasos recursos y con dificultad para llevar un adecuado control de anticoagulación.…”

“…La mortalidad reportada, cuando la cirugía se realiza en los dos primeros años de vida, se incrementa de 26 hasta 52%. 13,14 Se han reportado múltiples factores asociados a mortalidad en pacientes operados de reemplazo valvular mitral. Henaine y sus colaboradores encontraron que el diagnóstico de canal auriculoventricular completo, el síndrome de Shone, una relación tamaño de prótesis/peso mayor y la posición supra anular de la prótesis son factores asociados con mortalidad temprana.…”