1. Valve replacement in children: a challenge for a whole life
- Author
-
Mathieu Vergnat, Jean Ninet, François Roubertie, Roland Henaine, Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Haut Leveque Hosp, and Partenaires INRAE
- Subjects
Aortic valve ,ARTERY CONDUITS ,Time Factors ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Heart Valve Diseases ,Prosthesis ,LATE FOLLOW-UP ,Valve replacement ,LONG-TERM OUTCOMES ,PROSTHETIC VALVE ,MITRAL-VALVE ,YOUNG-ADULTS ,Ventricular outflow tract ,Child ,Heart Valve Prosthesis Implantation ,Tricuspid valve ,Ross procedure ,Age Factors ,General Medicine ,Pulmonary ,Heart Valves ,medicine.anatomical_structure ,Treatment Outcome ,Cardiothoracic surgery ,Paediatric ,Child, Preschool ,Heart Valve Prosthesis ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,Tricuspid ,medicine.medical_specialty ,Adolescent ,Pulmonaire ,Remplacement valvulaire ,Prosthesis Design ,Pédiatrique ,OUTFLOW TRACT RECONSTRUCTION ,Mitral ,medicine ,Humans ,Aortique ,AORTIC-STENOSIS ,Bioprosthesis ,Mitrale ,business.industry ,ROSS OPERATION ,Mitral valve replacement ,Aortic ,Infant ,UTILIZING PULMONARY VENTRICLE ,Surgery ,Tricuspide ,business - Abstract
Valvular pathology in infants and children poses numerous challenges to the paediatric cardiac surgeon. Without question, valvular repair is the goal of intervention because restoration of valvular anatomy and physiology using native tissue allows for growth and a potentially better long-term outcome. When reconstruction fails or is not feasible, valve replacement becomes inevitable. Which valve for which position is controversial. Homograft and bioprosthetic valves achieve superior haemodynamic results initially but at the cost of accelerated degeneration. Small patient size and the risk of thromboembolism limit the usefulness of mechanical valves, and somatic outgrowth is an universal problem with all available prostheses. The goal of this article is to address valve replacement options for all four valve positions within the paediatric population. We review current literature and our practice to support our preferences. To summarize, a multitude of opinions and surgical experiences exist. Today, the valve choices that seem without controversy are bioprosthetic replacement of the tricuspid valve and Ross or Ross-Konno procedures when necessary for the aortic valve. On the other hand, bioprostheses may be implanted when annular pulmonary diameter is adequate; if not or in case of right ventricular outflow tract discontinuity, it is better to use a pulmonary homograft with the Ross procedure. Otherwise, a valved conduit. Mitral valve replacement remains the most problematic; the mechanical prosthesis must be placed in the annular position, avoiding oversizing. Future advances with tissue-engineered heart valves for all positions and new anticoagulants may change the landscape for valve replacement in the paediatric population. (C) 2012 Elsevier Masson SAS. All rights reserved.
- Published
- 2012