PMID- 10773566
OWN - NLM
STAT- MEDLINE
DCOM- 20000620
LR  - 20190513
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 17
IP  - 4
DP  - 2000 Apr
TI  - Mitral-valve replacement in children under 6 years of age.
PG  - 426-30
AB  - OBJECTIVE: In patients with congenital mitral-valve disease, reconstructive 
      surgery is the primary goal. However, in cases with severely dysplastic valves or 
      failed repair, mitral-valve replacement (MVR) is the only option. We analyzed, 
      retrospectively, data of 35 patients younger than 6 years of age, who underwent 
      MVR at our institution. METHODS: Between 1974 and 1997, 35 children underwent 
      MVR. The ages ranged from 2.7 months to 5.5 years (mean=1. 9+/-1.7 years) and 
      body weight varied between 3.2 and 16.7 kg (mean=8.2+/-4 kg). The main indication 
      (57%) for valve replacement was severe mitral-valve insufficiency. Eighteen 
      patients (51%) had undergone at least one previous reconstructive operation 
      (mean=1. 46+/-1.86 years) before the MVR. In 29 cases (83%), mechanical 
      prostheses were implanted. Six patients received a bioprosthesis. The size of the 
      prostheses ranged between 14 and 27 mm. RESULTS: The overall hospital mortality 
      was 17.1% (6/35), and decreased from 33 (1974-1985) to 11.5% (1986-1997). Seven 
      children died late. The actuarial survival after 20 years was 51.2+/-13.3%. Eight 
      patients (23%) required 10 reoperations (8.2%/100 patient-years). Freedom from 
      reoperation at 10 years was 50+/-22%. Valve-related complications were 
      thrombo-embolism (n=2; 1.6%/100 patient-years), hemorrhage (n=1; 0.8%/100 
      patient-years), structural deterioration (n=3; 2.5%/100 patient-years) and 
      non-structural dysfunction (n=3; 2. 5%/100 patient-years). Follow-up is 96% 
      complete, with a total of 122 patient-years (mean=4.2+/-4.7 years). Eighty six 
      percent of the patients are in New York Heart Association (NYHA) class I, 95% 
      have sinus rhythm and 59% do not need medication. All survivors, except for those 
      who received a bioprosthesis, were placed on a regimen of Phenprocoumon 
      (Marcumar((R))), aiming to maintain the International Normalized Ratio (INR) 
      between 2.5 and 3.5. In one third of these children, self-management of oral 
      anticoagulation was performed either by the patients or their parents. 
      CONCLUSIONS: MVR in small children still carries a high risk. In our experience, 
      the long-term results are satisfying. After failed reconstructive surgery, or as 
      a primary procedure, we prefer mechanical prostheses. They are well tolerated and 
      the incidence of anticoagulation-related complications is low.
FAU - Gunther, T
AU  - Gunther T
AD  - Klinik fur Herz- und Gefasschirurgie, Deutsches Herzzentrum, Klinik an der 
      Technischen, Universitat Munchen, Lazarettstrasse 36, 80636, Munich, Germany. 
      chinfo@dhm.mhn.de
FAU - Mazzitelli, D
AU  - Mazzitelli D
FAU - Schreiber, C
AU  - Schreiber C
FAU - Wottke, M
AU  - Wottke M
FAU - Paek, S U
AU  - Paek SU
FAU - Meisner, H
AU  - Meisner H
FAU - Lange, R
AU  - Lange R
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Chi-Square Distribution
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Heart Valve Prosthesis Implantation/*methods/mortality
MH  - Humans
MH  - Infant
MH  - Male
MH  - Mitral Valve/surgery
MH  - Mitral Valve Insufficiency/diagnosis/mortality/*surgery
MH  - Probability
MH  - Prognosis
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Treatment Outcome
EDAT- 2000/04/25 09:00
MHDA- 2000/06/24 11:00
CRDT- 2000/04/25 09:00
PHST- 2000/04/25 09:00 [pubmed]
PHST- 2000/06/24 11:00 [medline]
PHST- 2000/04/25 09:00 [entrez]
AID - S1010-7940(00)00353-5 [pii]
AID - 10.1016/s1010-7940(00)00353-5 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2000 Apr;17(4):426-30. doi: 
      10.1016/s1010-7940(00)00353-5.