MITRAL-VALVE REPLACEMENT WITH THE ST-JUDE MEDICAL MECHANICAL PROSTHESIS IN CHILDREN UNDER 2 YEARS OF AGE

The authors report their experience of mitral valve replacement in infants under 2 years of age. A St Jude medical mitral prosthesis was implanted in 8 children, 7 with mitral regurgitation and 1 with mitral stenosis. The average age at surgery was 9 months with an average body weight of 6.6 Kg. Two children had prior mitral valvuloplasty. All patients were in the NYHA functional Class IV. One patient died after surgery (12.5 %). There was one secondary death during follow-up. Six children were followed up for an average of 61 months (range 34 to 104 months). The 6 survivors are asymptomatic and receive oral anticoagulant therapy. Regular postoperative Doppler echocardiographic assessment has shown a gradual increase of the mean transprosthetic pressure gradient in all children. To date, no reoperation on the prosthetic valve has been necessary. Mitral valve replacement is an effective option in infants with severe cardiac failure in whom mitral valve repair is impossible. In these cases, the St Jude medical prosthesis is a good choice. Effective anticoagulation is recommended, even at this age. Growth of the child will necessitate changing the prosthesis in later years.