Valve Replacement in Children: Guidelines for Selection of Prosthesis and Timing of Surgical Intervention

Ilbawi, Michel N.; Idriss, Farouk S.; DeLeon, Serafin Y.; Muster, Alexander J.; Duffy, C.Elise; Gidding, Samuel S.; Paul, Milton H.

doi:10.1016/s0003-4975(10)63800-3

Cited by 46 publications

(18 citation statements)

References 19 publications

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“…AVR in children is fraught with special hazards like frequent congenital heart malformations, small cardiac structures that add to the technical difficulties of operation, frequent dental problems, dependency on others for meticulous postoperative care, need for long-term anticoagulation therapy, and higher mortality and complication rates [2,4,16].…”

Section: Discussionmentioning

confidence: 99%

“…Valve replacement in children is fraught with myriad of potential problems including bleeding or embolic events or both associated with anticoagulation therapy, valve dysfunction including valve degeneration, and the need for valve re-replacement because of somatic growth over a normal life-span [1,2]. The common complications range from being a nuisance with no permanent sequelae to lifethreatening events [3,4].…”

Section: Introductionmentioning

confidence: 99%

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Evolution of aortic valve replacement in children: A single center experience

Ruzmetov

Vijay

Rodefeld

et al. 2006

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evolution of aortic valve replacement in children: A single center experience

Ruzmetov

Vijay

Rodefeld

et al. 2006

International Journal of Cardiology

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“…Results of prosthetic valve replacement in children have documented that delayed valvular insertion fails to improve LV ejection fraction whereas early replacement normalizes a reduced ejection fraction. 13 Mortality rates range from 3% to 12%, and thromboembolic complications range from 12% to 57%.14·17…”

Section: Discussionmentioning

confidence: 99%

Normal Left Ventricular Function Following Pulmonary Autograft Replacement of the Aortic Valve in Children

Santangelo

Elkins²,

Stelzer³

et al. 1991

Journal of Cardiac Surgery

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To assess growth potential and hemodynamic sequelae of pulmonary autograft valves implanted into aortic outflow tracts of children, we reviewed our experience with 37 patients (2‐21 years) from August 1986 to December 1990. Twenty patients had predominantly aortic stenosis (AS), and 17 had aortic insufficiency (AI). Operative mortality was 3%. Two technical failures required reoperation. Of survivors, six (18%) have moderate AI. Pre‐ and postoperative echocardiograms were reviewed. The AS group showed increased left ventricular (LV) cavity size by > 1‐year follow‐up, and decreased LV wall and Interventricular septal thickness. In the AI group, wall and septal thickness increased by 10 days and LV cavity decreased by 10 days, 60 days, and > 1 year. Root replacements (n = 14) showed mean increases of 4.3 mm and 5.3 mm, respectively, in diameters of the aortic annulus and aortic sinuses at > 1 year. Intraaortic implants increased 3.1 mm (annulus) and 3.9 mm (sinuses) at > 1 year. The pulmonary autograft procedure is safe, and successful implantation normalizes LV dimensions and function rapidly. The autograft valve shows evidence of growth at > 1 year postoperative. The pulmonary autograft may be the ideal valve replacement in children.

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“…Congenital pulmonary insufficiency is initially well tolerated [1], However, severe untreated pulmonary valvar insufficiency progresses to right ventricular dilation, loss of biventricular systolic function, and deterioration in symptomatic status of most patients by 35-40 years of age but earlier in some [2,3]. Restoring pulmonary valve sufficiency in young patients improves biventricular function and reduces symptoms [2], although the optimal timing for intervention remains unclear as there is no clear replacement solution [1,4,5]. Bioprosthetic valves and homografts are the choice for valve replacement in older adults, but these will need to be replaced in younger patients.…”

Section: Introductionmentioning

confidence: 99%

In Vitro Study of Flow Regulation for Pulmonary Insufficiency

Camp

Stewart

Figliola

et al. 2006

Journal of Biomechanical Engineering

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Given the tolerance of the right heart circulation to mild regurgitation and gradient, we study the potential of using motionless devices to regulate the pulmonary circulation. In addition, we document the flow performance of two mechanical valves. A motionless diode, a nozzle, a mechanical bileaflet valve, and a tilting disk valve were tested in a pulmonary mock circulatory system over the normal human range of pulmonary vascular resistance (PVR). For the mechanical valves, regurgitant fractions (RFs) and transvalvular pressure gradients were found to be weak functions of PVR. On the low end of normal PVR, the bileaflet and tilting disk valves fluttered and would not fully close. Despite this anomaly, the regurgitant fraction of either valve did not change significantly. The values for RF and transvalvular gradient measured varied from 4 to 7% and 4 to 7 mm Hg, respectively, at 5 lpm for all tests. The diode valve was able to regulate flow with mild regurgitant fraction and trivial gradient but with values higher than either mechanical valve tested. Regurgitant fraction ranged from 2 to 17% in tests extending from PVR values of 1 to 4.5 mm Hg/lpm at 5 lpm and with concomitant increases in gradient up to 17 mm Hg. The regurgitant fraction for the nozzle increased from 2 to 23% over the range of PVR with gradients increasing to 18 mm Hg. The significant findings were: (1) the mechanical valves controlled regurgitation at normal physiological cardiac output and PVR even though they failed to close at some normal values of PVR and showed leaflet flutter; and (2) it may be possible to regulate the pulmonary circulation to tolerable levels using a motionless pulmonary valve device.

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Valve Replacement in Children: Guidelines for Selection of Prosthesis and Timing of Surgical Intervention

Cited by 46 publications

References 19 publications

Evolution of aortic valve replacement in children: A single center experience

Evolution of aortic valve replacement in children: A single center experience

Normal Left Ventricular Function Following Pulmonary Autograft Replacement of the Aortic Valve in Children

In Vitro Study of Flow Regulation for Pulmonary Insufficiency

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