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The Journal of Thoracic and Cardiovascular Surgery, Vol 100, 762-768, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
K Kadoba, RA Jonas, JE Mayer and AR Castaneda
From 1973 through 1987 25 patients underwent mitral valve replacement in
the first year of life for mitral stenosis and mitral regurgitation. The
patients with mitral stenosis included two with mitral arcade, two with
supravalvular mitral stenosis with hypoplastic mitral valve, and one with
parachute mitral valve. Included in the group of patients with mitral
regurgitation were 12 with atrioventricular canal defect, six with chordal
and leaflet defects, one with Marfan's syndrome, and one with bacterial
endocarditis. Prostheses included 12 Bjork-Shiley (17 mm), seven St. Jude
Medical (19 mm in four, 21 mm in three), five stent- mounted dura mater
valves (12 mm to 16 mm), and one porcine xenograft (19 mm). In four
patients the valves were placed in the left atrium in a supraannular
location. There were nine operative (atrioventricular canal defect seven,
mitral regurgitation two) and five late (atrioventricular canal defect
four, mitral stenosis one) deaths, giving actuarial 1- and 5-year survival
rates of 52% and 43%, respectively. All 6 patients with tissue valves died;
the four with supraannular mitral valve replacement survived. Since 1983
operative mortality has been reduced to 0% (70% confidence limits 0% to
24%). Nine patients required a second mitral valve replacement for
prosthetic stenosis 5 to 69 (mean 30) months after the original mitral
valve replacement (one operative death). Because of improvements in repair
of atrioventricular canal defect in infancy, the need for mitral valve
replacement at atrioventricular canal defect repair has decreased. Although
valvuloplasty has been advocated for repair of congenital mitral valve
disease and is applicable in some infants with mitral regurgitation, mitral
valve replacement is frequently unavoidable for congenital mitral disease
and can now be accomplished at a low operative risk, even when the
prosthesis has to be positioned supraannularly.
ARTICLES
Mitral valve replacement in the first year of life
Department of Cardiac Surgery, Children's Hospital, Boston, Mass 02115.
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