The Journal of Thoracic and Cardiovascular Surgery, Vol 73, 872-876, Copyright © 1977 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Valve replacement in children and adolescents
RA Mathews, SC Park, WH Neches, CC Lenox, JR Zuberbuhler, FJ Fricker, RD Siewers, RL Hardesty, DB Lerberg and HT Bahnson
Replacement of diseased heart valves has become the treatment of choice in
many adults. Valve replacement in older children and adolescents has been
done in our institution only when other procedures are ineffective. Over
the past 10 years, 24 patients have received 28 artificial valves. Thirteen
(54 per cent) had rheumatic heart disease; the remainder had congenital or
acquired valvular abnormalities. The Bjork-Shiley valve was most commonly
used in the aortic position and the Beall prosthesis in the mitral
position. Sixteen patients (67 per cent) survived operation and have been
followed from 3 to 79 months, averaging 27 months. All are free of cardiac
symptoms. Hemarthrosis occurred once in 2 survivors (13 per cent). Eight
patients died (33 per cent), 5 immediately postoperatively and 3 within a
year after the operation. The mortality rate has declined to 21 percent
during the past 3 years. Our experience in the pediatric age group suggests
that valve replacement is a serious undertaking with higher mortality rate
than in adults. The operation should be reserved for those patients in whom
valvuloplasty or valvulotomy is expected to be ineffective.
