Heart valve replacement in children

Twenty children with heart valve disease were operated upon and underwent heart valve replacement between 1965 and 1968. Thirteen were girls and seven boys. At the time of operation their ages ranged from 3 to 16 years. All the patients were in classes III or IV prior to operation. Three children suffered from congenital valvular lesions and 17 from rheumatic lesions. In each patient left and/or right heart catheterization and angiographic studies were performed. Six patients underwent aortic valve replacement, 11 mitral, 1 tricuspid, and 2 double valve replacement. Mitral annuloplasty was performed in addition to aortic valve replacement in two patients, and tricuspid annuloplasty in addition to mitral valve replacement in another patient. In 19 patients a prosthetic valve was used and in one an aortic heterograft (pig). Two patients died in the early postoperative period (10%), and two later, two and nine months after surgery (10%). Postoperative thromboembolism occurred in four patients (20%). All have completely recovered. All the surviving 16 patients have been followed for a period of one to four and a half years and all showed significant clinical improvement; all children of school age have returned to school and/or other normal actitivies. The overall result has been encouraging and might justify a more aggressive approach in the management of valvular diseases in this specific group of patients.