Our Summary

This research paper discusses the challenges of mitral valve replacement (MVR), a heart surgery, in very young children. The risk of death after the operation is high and serious complications are common. The child will also inevitably need another MVR surgery in the future. There are not many treatment options available. For older babies who have a larger heart valve (17mm or larger), a mechanical MVR has a low risk of death and the replaced valve lasts a predictable amount of time. For very young babies with a smaller heart valve, using a bovine (cow) jugular vein for the MVR seems to offer the same or better results in the short term, and may delay the need for another MVR surgery. The use of other types of MVRs, including those made by surgeons, is not well studied, and we do not know how well they work in the long term.

FAQs

  1. What are the risks associated with mitral valve replacement (MVR) in very young patients?
  2. What are the potential benefits of using a bovine jugular vein conduit MVR in young patients with annular hypoplasia?
  3. What is the current understanding of the long-term outcomes and durability of cylinder MVR and other types of surgeon-manufactured MVR?

Doctor’s Tip

A helpful tip a doctor might tell a patient about mitral valve replacement is to follow a healthy lifestyle post-surgery, including maintaining a balanced diet, regular exercise, and avoiding smoking. This can help improve overall heart health and potentially increase the longevity of the replacement valve. It is also important to attend regular follow-up appointments with your healthcare provider to monitor the function of the new valve and address any concerns or complications promptly.

Suitable For

Patients who are typically recommended for mitral valve replacement include those with severe mitral valve disease, such as mitral valve stenosis or regurgitation, that is causing significant symptoms or complications. This can include patients with congenital heart defects affecting the mitral valve, as well as acquired conditions such as rheumatic heart disease or endocarditis. Patients who are not candidates for mitral valve repair or other less invasive treatments may also be recommended for mitral valve replacement. Additionally, patients who have had previous mitral valve surgery and require a redo procedure may be candidates for mitral valve replacement.

Timeline

Before mitral valve replacement:

  • Patient is diagnosed with a severe mitral valve condition, such as mitral valve stenosis or regurgitation
  • Patient may experience symptoms such as shortness of breath, fatigue, chest pain, and heart palpitations
  • Patient undergoes various diagnostic tests, such as echocardiograms and cardiac catheterization, to assess the severity of the condition
  • Patient may undergo medical management to control symptoms and improve heart function

After mitral valve replacement:

  • Patient undergoes surgery to replace the damaged mitral valve with a mechanical or biological valve
  • Patient is monitored closely in the hospital for complications and to ensure the new valve is functioning properly
  • Patient may need to take blood thinners to prevent blood clots forming on the new valve
  • Patient undergoes cardiac rehabilitation to improve heart function and physical strength
  • Patient is followed up regularly by their healthcare team to monitor the new valve and overall heart health.

What to Ask Your Doctor

  1. What are the risks and benefits of mitral valve replacement in my particular case?
  2. What type of mitral valve replacement is recommended for me (mechanical, bovine jugular vein conduit, cylinder, etc.) and why?
  3. What is the expected durability of the replacement valve?
  4. What is the expected recovery time after mitral valve replacement surgery?
  5. What lifestyle changes or restrictions will I need to follow after the surgery?
  6. What complications should I watch out for post-surgery?
  7. Will I need to take medication long-term after the surgery?
  8. How often will I need follow-up appointments to monitor the replacement valve?
  9. What signs or symptoms should prompt me to seek medical attention after the surgery?
  10. Are there any specific dietary or exercise recommendations I should follow to support my recovery after mitral valve replacement surgery?

Reference

Authors: Overman DM, Moga FX, Stephens EH, Dearani JA, MacIver RH. Journal: Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2023;26:75-80. doi: 10.1053/j.pcsu.2023.01.001. Epub 2023 Jan 16. PMID: 36842801