Abstract
Introduction. At implantation of the mechanical valve at children's and teenage age there are a constant need for intake of anticoagulants, a possibility of development of tromboemboliya and hemorrhagic complications, need for carrying out repeated operation in connection with dysfunction of an artificial limb or emergence of discrepancy of the size of an artificial limb of surface area of a body of the child with his growth.
Objective. To study the most often found complications in the remote terms after the operation of prosthetics of the aortal valve executed at children's and teenage age and to define ways of their prevention.
Material and methods. 120 patients after prosthetics of the aortal valve, from them 90 (75%) – a male, 30 (25%) – a female are examined. The age at the time of operation varied 3 up to 18 years (on average 12.7±3.3 years). Frequency of development of bleedings was 5%, tromboemboly 7.5%. Repeated surgical interventions are carried out 20 (16.7%) to patients.
Conclusion. Constant control of antikoagulyantny therapy and regular observation of the cardiologist in the cardiac center with carrying out tool inspections are necessary for prevention and effective treatment of complications.
References
- Самсонов В.Б., Подзолков В.П., Данилов Т.Ю., Чиаурели М.Р., Нежлукто А.А., Хальвани М.Ю. и др. Причины дисфункции механических протезов в аортальной позиции у детей. Сердечно-сосудистые заболевания. Бюллетень НЦССХ им.А.Н. Бакулева РАМН. 2017; 18 (S6): 7. [Samsonov V.B., Podzolkov V.P., Danilov T.Yu., Chiaureli M.R., Nezhlukto A.A., Khal'vani M.Yu. et al. The reasons of dysfunction of mechanical artificial limbs in an aortal position at children. The Bulletin of Bakoulev Center for Cardiovascular Diseases. 2017; 18 (S6): 7 (in Russ.)].
- 2014 AHA/ACC guideline for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association. J. Am. Coll. Cardiol. 2014; 63: 57–185. DOI: 10.1016/j.jtcvs. 2014. 05.014
- Nguyen N., Sharathkumar A. Current perioperative anticoagulation practices in children with prosthetic mechanical heart valves. Congenit. Heart Dis. 2015; 10 (5): 210–5. DOI: 10.1111/chd.12268
- Koertke H., Minami K., Boethig D., Breymann T., Seifert D., Wagner O. et al. INR self-management permits lower anticoagulation levels after mechanical heart valve replacement. Circulation. 2003; 108: II-75–8. DOI: 10.1161/01.cir. 0000089185.80318.3f
- Etnel J.R., Elmont L.C., Ertekin E., Mokhles M.M., Heuvelman H.J., Roos-Hesselink J.W. et al. Outcome after aortic valve replacement in children: A systematic review and meta-analysis J. Thorac. Cardiovasc. Surg. 2016; 151: 143–52. DOI: 10.1016/j.jtcvs.2015.09.083
- Bourguignon T., Bouquiaux-Stablo A.L., Candolfi P., Mirza A., Loardi C., May M.A. et al. Very long-term outcomes of the Carpentier-Edwards Perimount valve in aortic position. Ann. Thorac. Surg. 2015; 99: 831–7. DOI: 10.1016/j.athoracsur.2014.09.030
- Sharabiani M.T.A., Dorobantu D.M., Mahani A.S., Turner M., Peter Tometzki A.J., Angelini G.D. et al. Aortic valve replacement and the Ross operation in children and young adults. J. Am. Coll. Cardiol. 2016; 67: 2858–70. DOI: 10.1016/j.jacc. 2016.04.021
- Soulatges C., Momeni M., Zarrouk N., Moniotte S., Carbonez K., Barrea C. et al. Long-term results of balloon valvuloplasty as primary treatment for congenital aortic valve atenosis: a 20year review. Pediatr. Cardiol. 2015; 36: 1145–52. DOI: 10.1007/s00246-015-1134-4
- Skillington P.D., Mokhles M.M., Takkenberg J.J., Larobina M., O'Keefe M., Wynne R. et al. The Ross procedure using autologous support of the pulmonary autograft: techniques and late results. J. Thorac. Cardiovasc. Surg. 2015; 149: 46–52. DOI: 10.1016/j.jtcvs.2014.08.068
- David T.E. Aortic valve replacement in children and young adults. J. Am. Coll. Cardiol. 2016; 67 (24): 2871–3. DOI: 10.1016/j.jacc.2016.04.023
- Sharabiani M.T., Dorobantu D.M., Mahani A.S., Turner M., Tometzki A.J.P., Gianni D. et al. aortic valve replacement and the ross operation in children and young adults. J. Am. Coll. Cardiol. 2016; 67 (24): 2858–70. DOI: 10.1016/j.jacc. 2016.04.021
- Masuda M., Kado H., Ando Y., Shiose A ., Nakano T., Fukae K. et al. Intermediate-term results after the aortic valve replacement using bileaflet mechanical prosthetic valve in children. Eur. J. Cardiothorac. Surg. 2008; 34 (1): 42–7. DOI: 10.1016/j.ejcts.2008.04.005
- Arnold R., Ley-Zaporozhan J., Ley S., Loukanov T., Sebening C., Kleber J.B. et al. Outcome after mechanical aortic valve replacement in children and young adults. Ann. Thorac. Surg. 2008; 85: 604–10. DOI: 10.1016/j.athoracsur. 2007.10.035
- Edwin F., Aniteye E., Tettey M.M. Outcome of left heart mechanical valve replacement in West African children – A 15-year retrospective study. J. Cardiothorac. Surg. 2011; 6: 57. DOI: 10.1186/1749-8090-6-57
- Ruzmetov M., Vijay P., Rodefeld M.D., Turrentine M.W., Brown J.W. Evolution of aortic valve replacement in children: A single center experience. Int. J. Cardiology. 2006; 113: 194–200.
- Niaz T., Poterucha J.T., Johnson J.N., Craviari C., Nienaber T., Palfreeman J. et al. Incidence, morphology, and progression of bicuspid aortic valve in pediatric and young adult subjects with coexisting congenital heart defects. Congenit. Heart Dis. 2017; 12 (3): 261–9. DOI: 10.1111/ chd.12429
- MalčićI., Grgat J., Kniewald H., šarićD., Dilber D., Bartoniček D. Bicuspid aortic valve and left ventricular outflow tract defects in children – syndrome of bicuspid aortopathy? Lijec Vjesn. 2015; 137 (9–10): 267–75.
About the authors
- Ol‘ga I. Medvedeva, Leading Researcher; Marina L. Ermolenko, Head of Department, orcid.org/0000-0002-7784-993X;
- Mariya N. Nevedrova, Researcher, orcid.org/000-0002-5469-8999;
- Viktor B. Samsonov, Leading Researcher, orcid.org/0000-0002-6477-7914;
- Timur Yu. Danilov, Leading Researcher, orcid.org/0000-0002-9409-3230;
- Dmitriy V. Kovalev, Leading Researcher, orcid.org/0000-0002-4586-9258;
- Vera I. Dontsova, Ultrasonic Diagnostics Physician, orcid.org/0000-0003-061573-19;
- Viktoriya V. Plakhova, Ultrasonic Diagnostics Physician, orcid.org/0000-0002-6010-953X
