[Mitral and aortic valve replacement in childhood].

Between 1970 to 1981, 23 patients aged under 18 years underwent mitral or aortic cardiac valve replacement at the University Hospital Hamburg. The mean age of the 12 male and 11 female patients was 10.8 years at the time of the operation, and they were followed up for an average of 3.4 years. 11 isolated aortic valve replacements and 10 mitral replacements were performed; there was 1 double and 1 triple heart valve replacement. 11 patients suffered from congenital and 9 from acquired heart disease, and in 3 cases a combination of the two was found. Altogether, 26 prosthetic valves were implanted, 23 mechanical and 3 bioprostheses. 18 of the 23 children operated upon are still alive. 1 child died 1 day after the operation and 4 children between some months and 4 years postoperatively. The general condition of all our living patients improved clearly. They do not show any signs of congestive heart failure, even under physical exercise, and nearly all of them are asymptomatic. Signs of left ventricular hypertrophy in the ECG decreased; so did the cardiothoracic ratio in the p.a. chest X-rays. No dangerous complications such as bacterial endocarditis, serious thromboembolisms , or periprosthetic leaks occurred in the surviving patients. 2 children had heavy bleedings, and in another patient signs of bacterial endocarditis and repeated thromboembolisms were found at autopsy. Valve disease with grade II congestive heart failure should be operated upon before irreversible damage appears and whenever heart catheterization findings are serious (e.g., stenoses of aortic valves with gradients of more than 75 mg Hg). First, it should be found out whether repair of the natural heart valve is feasible.(ABSTRACT TRUNCATED AT 250 WORDS)