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Replacement of Cardiac Valves in Children

Replacement of Cardiac Valves in Children Abstract Replacement of cardiac valves in childhood is infrequent primarily because of the rarity of anatomical lesions requiring valve replacement. Furthermore, there are uncertainties regarding the long-term fate of the prosthetic valve and the effects of a fixed-orifice valve in the growing child. In 15 children, 15 years old or younger, a cardiac valve was replaced because of congenital or acquired valvar heart disease. There were eight mitral valves, five aortic valves, and three tricuspid valves replaced. Indications for replacement were uncontrollable congestive heart failure or an apparently fatal course. Initial mortality was 25% with an additional 12.5% late deaths. Complications including embolization, mechanical "ball-valve failure," arrhythmias, hemolytic anemia, and difficulties with anticoagulants were not peculiar to childhood. Postoperative improvement was dramatic. Replacement should be considered before irreversible changes occur that preclude a satisfactory outcome. References 1. Starr A, Herr RH, Wood JA: Mitral replacement: Review of six years experience . J Thorac Cardiovasc Surg 54:333-358,1967. 2. Herr RH, Starr A, Pierie WR, et al: Aortic valve replacement: A review of six years' experience with the ball-valve prosthesis . Ann Thorac Surg 6:199-218,1968.Crossref 3. Bloodwell RE, Hallman GL, Cooley DA: Cardiac valve replacement in children . Surgery 63:77-89, 1968. 4. Taguchi K, Sasaki N, Matsuura Y, et al: The use of valve prosthesis in congenital heart disease in children and adolescents . J Thorac Cardiovasc Surg 55:800-810, 1968. 5. van de Water JM, Wolfe RR, Mulder DG: Total heart-valve replacement in the pediatric age group . J Thorac Cardiovasc Surg 53:515-518,1967. 6. Puyau FA, Little JA, Collins HA: Mitral valve prosthesis in childhood . Amer J Dis Child 108:651-656, 1964. 7. Ainger LE, Pate JW, Lawyer NG, et al: Prosthetic mitral valve replacement in children . J Pediat 70:577-585, 1967.Crossref 8. Rastelli GC, Wallace RB, Ongley PA, et al: Replacement of mitral valve in children with persistent common atrioventricular canal associated with severe mitral incompetence . Mayo Clin Proc 42:417-422,1967. 9. Smeloff EA, Cayler GC, Smith DF: The use of valve prostheses in childhood . J Thorac Cardiovasc Surg 51:839-843,1966. 10. Effler DB: Defects of the mitral valve: Current concepts of surgical treatment . Cleveland Clin Quart 29:167-176,1962.Crossref 11. Bonnabeau RC Jr, Lillehei CW: Mechanical "ball failure" in Starr-Edwards prosthetic valves . J Thorac Cardiovasc Surg 56:258-264,1968. 12. Hylen JC, Judkins MP, Herr RH, et al: Radiographic diagnosis of aortic-ball variance . JAMA 207:1120-1122, 1969.Crossref 13. Roberts WC, Morrow AG: Topics in clinical medicine: Anatomic studies of hearts containing caged-ball prosthetic valves . John Hopkins Med J 121:271-295, 1967. 14. McHenry MM, Smeloff EA, Hattersley PG: Complications of heart valve replacement: Embolism, bleeding and hemolysis . Calif Med 109:1-8,1968. 15. Akbarian M, Austen WG, Yurchak PM, et al: Thromboembolic complications of prosthetic cardiac valves . Circulation 37:826-831, 1968.Crossref 16. Harris LC, Nghiem OX, Schreiber MH: Rheumatic mitral insufficiency in children: Course, prognosis and effect of mitral valve replacement . Amer J Cardiol 17:194-202, 1966.'Crossref 17. Gannon PG, Sellers RD, Kanjuh VI, et al: Complete heart block following replacement of the aortic valve . Circulation 33:152-161,1966.Crossref 18. Stein PD, Harken DE, Dexter L: The nature and prevention of prosthetic valve endocarditis . Amer Heart J 71:393-407, 1966.Crossref 19. Goodman JS, Schaffner W, Collins HA, et al: Infection after cardiovascular surgery . New Eng J Med 278:117-123, 1968.Crossref 20. Fekety FR, Cluff LE, Sabiston DC, et al: A study of antibiotic prophylaxis in cardiac surgery . J Thorac Cardiovasc Surg 57:757-763, 1969. 21. Geraci JE, Dale AJD, McGoon DC: Bacterial endocarditis and endarteritis following cardiac operations . Wisconsin Med J 62:302-315,1963. 22. Andersen MN, Gabrieli E, Zizzi JA: Chronic hemolysis in patients with ball-valve prostheses . J Thorac Cardiovasc Surg 50:501-510,1965. 23. Yacoub MH, Keeling DH: Chronic haemolysis following insertion of ball valve prostheses . Brit Heart J 30:676-678, 1968.Crossref 24. Pirofsky B, Sutherland DW, Starr A, et al: Hemolytic anemia complicating aortic-valve surgery . New Eng J Med 272:235-239, 1965.Crossref 25. Walsh JR, Brodeur TH, Ritzmann LW, et al: Urinary iron excretion in patients with prosthetic heart valves . JAMA 198:91-96,1966.Crossref 26. Levy MJ, Varco RL, Lillehei CW, et al: Mitral insufficiency in infants, children and adolescents . J Thorac Cardiovasc Surg 45:434-450,1963. 27. Flege JB, Vlad P, Ehrenhaft JL: Congenital mitral incompetence . J Thorac Cardiovasc Surg 53:138-144,1967. 28. Kahn DR, Stern AM, Sigman JM, et al: Long term results of valvuloplasty for mitral insufficiency in children . J Thorac Cardiovasc Surg 53:1-6, 1967. 29. Ellis FH, Ongley PA, Kirklin JW: Ventricular septal defect with aortic valvular incompetence: Surgical considerations . Circulation 27:789-795, 1963.Crossref 30. Barratt-Boyes BG: Homograft replacement for aortic valve disease . Mod Conc Cardiovasc Dis 36:1-6,1967. 31. Braunwald NS, Detmer DE: A critical analysis of the status of prosthetic valves and homografts . Progr Cardiovasc Dis 11:113-132, 1968.Crossref 32. Wallace RB, Rastelli GC, Ongley PA, et al: Complete repair of truncus arteriosus defects . J Thorac Cardiovasc Surg 57:95-107,1969. 33. Weldon CS, Rowe RD, Gott VL: Clinic experience with use of aortic valve homografts for reconstruction of pulmonary artery, pulmonary valve and outflow portion of right ventricle . Circulation 2( (suppl 37) ):51-61,1968. 34. Levy MJ, Vidne B, Lebinshon S: Surgery for aortic valve: Prosthesis and heterograft . Surgery 66:313-318,1969. 35. Ablaza SGG, Blanco G, Maranhao V, et al: Calf aortic valve heterograft replacement for aortic valvular disease . Dis Chest 55:25-31,1969.Crossref 36. Ionescu MI, Ross DN: Heart-valve replacement with autologous fascia lata . Lancet 1:335-338,1969.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1970 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1970.02100110051003
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Abstract

Abstract Replacement of cardiac valves in childhood is infrequent primarily because of the rarity of anatomical lesions requiring valve replacement. Furthermore, there are uncertainties regarding the long-term fate of the prosthetic valve and the effects of a fixed-orifice valve in the growing child. In 15 children, 15 years old or younger, a cardiac valve was replaced because of congenital or acquired valvar heart disease. There were eight mitral valves, five aortic valves, and three tricuspid valves replaced. Indications for replacement were uncontrollable congestive heart failure or an apparently fatal course. Initial mortality was 25% with an additional 12.5% late deaths. Complications including embolization, mechanical "ball-valve failure," arrhythmias, hemolytic anemia, and difficulties with anticoagulants were not peculiar to childhood. Postoperative improvement was dramatic. Replacement should be considered before irreversible changes occur that preclude a satisfactory outcome. References 1. Starr A, Herr RH, Wood JA: Mitral replacement: Review of six years experience . J Thorac Cardiovasc Surg 54:333-358,1967. 2. Herr RH, Starr A, Pierie WR, et al: Aortic valve replacement: A review of six years' experience with the ball-valve prosthesis . Ann Thorac Surg 6:199-218,1968.Crossref 3. Bloodwell RE, Hallman GL, Cooley DA: Cardiac valve replacement in children . Surgery 63:77-89, 1968. 4. Taguchi K, Sasaki N, Matsuura Y, et al: The use of valve prosthesis in congenital heart disease in children and adolescents . J Thorac Cardiovasc Surg 55:800-810, 1968. 5. van de Water JM, Wolfe RR, Mulder DG: Total heart-valve replacement in the pediatric age group . J Thorac Cardiovasc Surg 53:515-518,1967. 6. Puyau FA, Little JA, Collins HA: Mitral valve prosthesis in childhood . Amer J Dis Child 108:651-656, 1964. 7. Ainger LE, Pate JW, Lawyer NG, et al: Prosthetic mitral valve replacement in children . J Pediat 70:577-585, 1967.Crossref 8. Rastelli GC, Wallace RB, Ongley PA, et al: Replacement of mitral valve in children with persistent common atrioventricular canal associated with severe mitral incompetence . Mayo Clin Proc 42:417-422,1967. 9. Smeloff EA, Cayler GC, Smith DF: The use of valve prostheses in childhood . J Thorac Cardiovasc Surg 51:839-843,1966. 10. Effler DB: Defects of the mitral valve: Current concepts of surgical treatment . Cleveland Clin Quart 29:167-176,1962.Crossref 11. Bonnabeau RC Jr, Lillehei CW: Mechanical "ball failure" in Starr-Edwards prosthetic valves . J Thorac Cardiovasc Surg 56:258-264,1968. 12. Hylen JC, Judkins MP, Herr RH, et al: Radiographic diagnosis of aortic-ball variance . JAMA 207:1120-1122, 1969.Crossref 13. Roberts WC, Morrow AG: Topics in clinical medicine: Anatomic studies of hearts containing caged-ball prosthetic valves . John Hopkins Med J 121:271-295, 1967. 14. McHenry MM, Smeloff EA, Hattersley PG: Complications of heart valve replacement: Embolism, bleeding and hemolysis . Calif Med 109:1-8,1968. 15. Akbarian M, Austen WG, Yurchak PM, et al: Thromboembolic complications of prosthetic cardiac valves . Circulation 37:826-831, 1968.Crossref 16. Harris LC, Nghiem OX, Schreiber MH: Rheumatic mitral insufficiency in children: Course, prognosis and effect of mitral valve replacement . Amer J Cardiol 17:194-202, 1966.'Crossref 17. Gannon PG, Sellers RD, Kanjuh VI, et al: Complete heart block following replacement of the aortic valve . Circulation 33:152-161,1966.Crossref 18. Stein PD, Harken DE, Dexter L: The nature and prevention of prosthetic valve endocarditis . Amer Heart J 71:393-407, 1966.Crossref 19. Goodman JS, Schaffner W, Collins HA, et al: Infection after cardiovascular surgery . New Eng J Med 278:117-123, 1968.Crossref 20. Fekety FR, Cluff LE, Sabiston DC, et al: A study of antibiotic prophylaxis in cardiac surgery . J Thorac Cardiovasc Surg 57:757-763, 1969. 21. Geraci JE, Dale AJD, McGoon DC: Bacterial endocarditis and endarteritis following cardiac operations . Wisconsin Med J 62:302-315,1963. 22. Andersen MN, Gabrieli E, Zizzi JA: Chronic hemolysis in patients with ball-valve prostheses . J Thorac Cardiovasc Surg 50:501-510,1965. 23. Yacoub MH, Keeling DH: Chronic haemolysis following insertion of ball valve prostheses . Brit Heart J 30:676-678, 1968.Crossref 24. Pirofsky B, Sutherland DW, Starr A, et al: Hemolytic anemia complicating aortic-valve surgery . New Eng J Med 272:235-239, 1965.Crossref 25. Walsh JR, Brodeur TH, Ritzmann LW, et al: Urinary iron excretion in patients with prosthetic heart valves . JAMA 198:91-96,1966.Crossref 26. Levy MJ, Varco RL, Lillehei CW, et al: Mitral insufficiency in infants, children and adolescents . J Thorac Cardiovasc Surg 45:434-450,1963. 27. Flege JB, Vlad P, Ehrenhaft JL: Congenital mitral incompetence . J Thorac Cardiovasc Surg 53:138-144,1967. 28. Kahn DR, Stern AM, Sigman JM, et al: Long term results of valvuloplasty for mitral insufficiency in children . J Thorac Cardiovasc Surg 53:1-6, 1967. 29. Ellis FH, Ongley PA, Kirklin JW: Ventricular septal defect with aortic valvular incompetence: Surgical considerations . Circulation 27:789-795, 1963.Crossref 30. Barratt-Boyes BG: Homograft replacement for aortic valve disease . Mod Conc Cardiovasc Dis 36:1-6,1967. 31. Braunwald NS, Detmer DE: A critical analysis of the status of prosthetic valves and homografts . Progr Cardiovasc Dis 11:113-132, 1968.Crossref 32. Wallace RB, Rastelli GC, Ongley PA, et al: Complete repair of truncus arteriosus defects . J Thorac Cardiovasc Surg 57:95-107,1969. 33. Weldon CS, Rowe RD, Gott VL: Clinic experience with use of aortic valve homografts for reconstruction of pulmonary artery, pulmonary valve and outflow portion of right ventricle . Circulation 2( (suppl 37) ):51-61,1968. 34. Levy MJ, Vidne B, Lebinshon S: Surgery for aortic valve: Prosthesis and heterograft . Surgery 66:313-318,1969. 35. Ablaza SGG, Blanco G, Maranhao V, et al: Calf aortic valve heterograft replacement for aortic valvular disease . Dis Chest 55:25-31,1969.Crossref 36. Ionescu MI, Ross DN: Heart-valve replacement with autologous fascia lata . Lancet 1:335-338,1969.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Dec 1, 1970

References