Mitral valve replacement in children with rheumatic heart disease.

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Abstract
Children (110), ages 6-15 yr, who had undergone mitral valve replacement for rheumatic heart disease were followed. Group 1 consisted of 74 patients with mechanical prostheses and a mean follow-up of 6.3 yr. Group 2 consisted of 13 patients with porcine xenografts followed for 3.3 yr. Group 3 included 23 children with dura mater bioprostheses and a mean follow-up of 1.9 yr. The clinical evolution of each group was assessed according to the New York Heart Association criteria. The incidence of complications also was determined; 95% confidence limits were calculated for all proportions from binomial distribution; lack of superposition was adopted as the criterion of significance. In group 1, thromboembolic complications occurred in 1.7%/patient per yr, infective endocarditis in 0.85%/patient per yr, valvular dysfunction in 0.85%/patient per yr and death in 1.3%/patient per yr. Group 2 patients had no thromboembolic complications; infective endocarditis occurred in 23%/patient per yr, dysfunction in 16.3%/patient per yr and death in 14%/patient per yr. Seven patients with Hancock porcine xenografts presented valve obstruction and 4 cases that were studied anatomically showed fibrocalcific obstruction of the prosthesis. In group 3, thromboembolic episodes occurred in 23%/patient per yr, dysfunction in 6.8%/patient per yr and death in 2.3%/patient per yr. Calcific obstruction of the prosthesis was observed in 1 patient at necropsy. Mechanical prostheses apparently offer the best results in children. With adequate anticoagulation, thromboembolism is of little significance, the incidence of infective endocarditis is comparable to that reported for bioprostheses, dysfunction is less frequent and the long-term mortality rate is lower.

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