Abstract
Objective. To study the most frequent complications in the late period after the replacement of mitral valve performed
in infancy and adolescency.
Material and methods. 102 patients were studied. Their age at the moment of operation was 3 months - 18 years
(mean 7.6 ± 5.1 years), follow-up period - 1 - 13 years (mean 5.3 ± 2.9 years), age at the moment of the study - 2.5 -
29 years (mean 12.8 ± .5 years). Mechanical prostheses were implanted: bicuspid St. Jude type - in 45 patients,
Carbomedics - in 9 patients, MedIng - in 4 patients as well as rotary disk MIKS («EMIKS») - in 43 patients and
Medtronic Hall - in 1 patient. All the patients had clinico-instrumental check-up including clinical examination,
ECG, EchoCG, radiography, INR assessment.
Results. EchoCG showed that 2 (2%) patients had reduced left ventricular ejection fraction up to 53%, 1 patient with
CTGA associated with systemic dysfunction of ventricle had reduced ejection fraction up to 45%. In another patient
this rate was reduced up to 26 - 30%. Paraprosthetic fistula with regurgitation 2+ was revealed in 2 (2%) patients.
Unsatisfactory INR rates were revealed on examination in 54 (53%) patients. Thromboembolic complications in history
such as acute cerebrovascular accident were found in 7 (6.9%) patients. Hemorrhages in history were noted in 6
(5.9%) patients.
12 patients had signs of prosthetic dysfunction: 8 patients underwent primary surgery at the age of 2 years or earlier,
2 patients - at the age of 3.5 years, 2 patients - at the age of 6 and 16.5 years. Follow-up period was 4 - 9 years
(6.6 ± 2.2 years at average). Increase of diastolic pressure gradient on prosthesis due to mismatch of prosthetis size and
body surface area was revealed in 8 patients aged from 6 to 14 years with prosthesis size from 19 to 23. Pannus formation
resulted in prosthetis dysfunction in 3 children which was confirmed at the reoperation. One 19-year old patient had thrombosis
of prosthesis due to warfarin withdrawal. 10 patients with prosthesis dysfunction underwent reoperations, two children
at the age of 7 and 12 years died. Thus, cumulative fraction of survived patients in a 10-year period was 91.1 ± 7.0%.
Infectious endocarditis was revealed in one case in 2.5 years after operation. This patient underwent successful conservative
treatment.
Conclusion. Long-term postoperative period after mitral valve replacement in children and adolescents is often associated
with such complications as thromboembolism, hemorrhages and prosthesis dysfunction. Adjustment of anticoagulants
has primary significance for prevention of thromboembolic and hemorrhagic complications and for prevention
of prosthesis dysfunction due to pannus formation or its thrombosis after mechanic prosthesis implantation for
maintenance of adequate INR target values.
References
Бокерия Л. А., Подзолков В. П., Хассан Али и др. Протезирование клапанов сердца у детей: хирургический подход и реальные возможности // Детские болезни сердца и сосудов. 2004. № 1. С. 73-81.
Alexiou C., Galogavrou M., Chen Q. et al. Mitral valve replacement with mechanical prostheses in children: improved operative risk and survival // Eur. J. Cardiothorac. Surg. 2001. Vol. 20. P. 105-113.
Alsoufi B., Manlhiot C., McCrindle B. W. et al. Results after mitral valve replacement with mechanical prostheses in young children // J. Thorac. Cardiovasc. Surg. 2010. Vol. 139. P. 1189-1196.
Beierlein W., Becker V., Yates R. et al. Long-term follow-up after mitral valve replacement in childhood: poor event-free survival in the young child // Eur. J. Cardiothorac. Surg. 2007. Vol. 31. P. 860-865.
Castilho Т., Menezes I., Queiros J. et al. Implantation of mechanical prosthetic valves in the pediatric age group. Review of the last ten years // Rev. Port. Cardiol. 1999. Vol. 18. P. 491-495.
Erez E., Kanter K. R., Isom E. et al. Mitral valve replacement in children // J. Heart Valve Dis. 2003. Vol. 12, № 1. P. 25-29.
Harada Y., Imai Y., Kurosawa H. et al. Ten-year follow-up after valve replacement with the St. Jude Medical prosthesis in children // J. Thorac. Cardiovasc. Surg. 1990. Vol. 100. P. 175-180.
Ibrahim M., Cleland J., OKane H. J. et al. St. Jude Medical prosthesis in children // J. Thorac. Cardiovasc. Surg. 1994. Vol. 108. P. 52-56.
Koertke H., Minami K., Boethig D. et al. INR self management permits lower anticoagulation levels after mechanical heart valve replacement // Circulation. 2003. Vol. 108 (Suppl. I). P. 75-78.
Lubiszewska B., Rozanski J., Szufladowicz M. Mechanical valve replacement in congenital heart disease in children // J. Heart Valve Dis. 1999. Vol. 8. P. 74-79.
Masuda M., Kado H., Tatewaki H. et al. Late results after mitral valve replacement with bileaflet mechanical prosthesis in children: eval uation of prosthesis-patient mismatch // Ann. Thorac Surg. 2004. Vol. 77. P. 913-917.
Rafii D. Y., Davies R. D., Carroll S. J. Age Less Than Two Years Is Not a Risk Factor for Mortality After Mitral Valve Replacement in Children // Ann. Thorac. Surg. 2011. Vol. 91. P. 1228-1234.
Ruel M., Kulik A., Lam B. K. et al. Long-term outcomes of valve replacement with modern prostheses in young adults // Eur. J. Cardiothorac. Surg. 2005. Vol. 27. P. 425-433.
Tierney E. S. S., Pigula F. A., Berul C. I. et al. Mitral valve replacement in infants and children 5 years of age or younger: Evolution in practice and outcome over three decades with a focus on supra-annular prosthesis implantation // J. Thorac. Cardiovasc. Surg. 2008. Vol. 136. P. 954-961.
Van Doorn C., R. Yates, V. Tsang et al. Mitral valve replacement in children: mortality, morbidity, and haemodynamic status up to medium term follow up // Heart. 2000. Vol. 84. P. 634-642.
Yu J., Gao H., Zhang G. et al. Valve replacement in pediatric patients: a single center experience // Chin. Med. J. 2011. Vol. 124. P. 218-222.
