Abstract
There is a set of problematic questions in management of mitral valve defects in childhood.
Implantation of mechanical valves is a method of choice for children, as the biological prosthetic
devices are exposed to early calcification and biodegradation. Mechanical valve requires
life-long anticoagulant therapy. Anticoagulation is well tolerated by children, but it has such
complications as bleeding and thromboembolism. According to different authors, the rates of
bleedings and thromboembolic events in past 10 years were 6-25% and 4-8%, respectively.
Optimal levels of anticoagulation in children and adults with prosthetic valves are probably
different, but there are no exact recommendations concerning anticoagulant therapy for children.
According to the data of different studies, the rates of long-term mortality and other
complications differ significantly. The differences are associated with a various contingent of
patients from 2 groups, time framework of studies and ability of long-term catamnesis. There
are different risk factors for long-term mortality: congenital mitral valve defect (in contrast to
acquired heart disease), cardiac reoperations, inability to preserve subvalvular mitral apparatus,
chronic mitral valve disease, age of less than 1-2 years old at the moment of operation,
presence of common atrioventricular canal, major difference between size of prosthesis and
body weight, necessity for pacemaker implantation in postoperative period. The most frequent
complications are: valve dysfunction, complete atrioventricular block with subsequent pacemaker
implantation and endocarditis. According to different authors, the requirement for
pacemaker implantation in children after mitral valve replacement due to complete atrioventricular
block varies from 0 to 24%. The incidence of endocarditis was 2-8%. Rate of mechanical
valve reimplantation was 0-75%, and the interval between first and second operation varied
significantly. It depends on the age gap at the moment of surgery, type and size of prosthetic
devices, duration of catamnesis. There are no exact guidelines concerning the
reoperations in pediatric patients. Transprosthetic Doppler flow of more than 2.2 m/s and
effective orifice area of less than 1.3 cm2/m2 were the determinants of «outgrowing» the mitral
valve prosthesis. There are no publications in Russian literature dedicated to life-quality
research in children with mitral valve prostheses. Foreign study showed the decreased quality
of life in comparison with healthy children from junior group and normal or subnormal quality
of life in children of 15-year old or more.
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