Our Summary

This research paper looks into the treatment of a specific heart disease in babies and young children. This heart disease affects the mitral valve, a part of the heart that ensures blood flows in the right direction. Surgery on this part of the heart is difficult and risky, and replacing the valve is usually seen as a last resort because it often leads to more health problems and even death.

The paper suggests that mechanical valves, a type of artificial heart valve, are the best choice for larger mitral valves. For smaller ones, a different kind of replacement called a stented conduit may be safer and more promising.

For patients whose mitral valve is equal to or larger than 15-16 mm, surgeons should try to fit the smallest available mechanical valve inside the natural valve. If the patient’s mitral valve is smaller, using a stented valved conduit may lower the risk of death.

The authors caution that placing artificial valves above the natural valves should only be done in special cases, and only by surgeons who are highly experienced with this technique, due to the high risk of further complications.

FAQs

  1. What is the preferred method for mitral valve replacement in infants with larger annuli?
  2. What is the suggested method for mitral valve replacement in neonates with smaller annuli to reduce mortality risk?
  3. When should supra-annular implantation of prostheses be considered in mitral valve replacement in infants?

Doctor’s Tip

One helpful tip a doctor might tell a patient about mitral valve replacement is to carefully consider the type and placement of the prosthetic valve. Mechanical valves are often preferred in larger annuli, while stented conduits may be a better option for smaller annuli. In cases where the mitral valve annulus is small, the placement of a stented valved conduit may have lower mortality risks. It is important for the surgeon to have experience with the chosen technique to minimize complications.

Suitable For

Patients who are typically recommended mitral valve replacement include those who are neonates or infants with congenital mitral valve disease, in cases where repair is no longer feasible. This option should only be considered as a last resort due to the high rate of associated morbidity and mortality. Mechanical valves are preferred in patients with large annuli, while stented conduits may be a better option for those with smaller annuli. In patients with a preoperative mitral valve annulus equal or larger than 15-16 mm, an intra-annular placement of the smallest mechanical valve available is recommended. For patients with smaller annuli, the placement of a stented valved conduit may be associated with lower mortality risk. Supra-annular implantation of prostheses should be reserved for exceptional cases and those familiar with the technique due to the high rate of associated complications.

Timeline

Before mitral valve replacement:

  1. The patient is diagnosed with mitral valve disease, which may be congenital or acquired.
  2. Symptoms such as shortness of breath, fatigue, chest pain, and palpitations may develop as the condition progresses.
  3. The patient undergoes various diagnostic tests such as echocardiography, cardiac catheterization, and MRI to assess the severity of the valve disease.
  4. Treatment options such as medication, lifestyle changes, and minimally invasive procedures may be considered initially to manage symptoms and delay the need for surgery.
  5. As the disease worsens and conservative measures are no longer effective, the patient may be evaluated for mitral valve replacement.

After mitral valve replacement:

  1. The patient undergoes surgery to replace the damaged mitral valve with a mechanical or bioprosthetic valve.
  2. Following surgery, the patient is closely monitored in the intensive care unit for several days to ensure proper healing and function of the new valve.
  3. Physical therapy and rehabilitation may be initiated to help the patient regain strength and mobility.
  4. The patient may need to take blood-thinning medications to prevent blood clots from forming on the new valve.
  5. Regular follow-up appointments with the cardiologist are scheduled to monitor the function of the new valve and overall heart health.
  6. With proper care and adherence to medical recommendations, the patient can expect improved symptoms and quality of life following mitral valve replacement.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with mitral valve replacement surgery?

  2. How long is the recovery process after mitral valve replacement surgery?

  3. Will I need to take medication for the rest of my life after the surgery?

  4. How often will I need to follow up with you after the surgery?

  5. Are there any lifestyle changes I need to make after the surgery?

  6. Will I need to undergo any additional procedures or treatments in the future?

  7. What is the expected lifespan of the prosthetic valve?

  8. Are there any restrictions on physical activity or exercise after the surgery?

  9. How will mitral valve replacement surgery affect my overall heart health and function?

  10. Are there any support groups or resources available for patients who have undergone mitral valve replacement surgery?

Reference

Authors: Caldaroni F, Brizard CP, d’Udekem Y. Journal: Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2021;24:57-61. doi: 10.1053/j.pcsu.2021.03.006. PMID: 34116783