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Results of the Mechanical Valve Replacement in the Right Side of the Heart in Children

Journal of the Korean Pediatric Society 1995;38(9):1220-1231.
Published online September 15, 1995.
Results of the Mechanical Valve Replacement in the Right Side of the Heart in Children
Hyeon Jin Park, Chung Il Noh, Ho Sung Kim, Jung Yun Choi, Yong Soo Yun, Yong Jin Kim
Department of Pediatrics and Thoracic Surgery, Seoul National University, College of Medicine, Seoul, Korea
소아 우측 심장 판막의 기계 판막 치환술 결과
박현진, 노정일, 김호성, 최정연, 윤용수, 김용진
서울대학교 의과대학 소아과학교실, 소아흉부외과학교실
Abstract
Purpose
: We performed this study in order to evaluate the outcome of the mechanical valve replacement in the right side of the heart in children.
Methods
: Retrospective analysis of the clinical records of 26 patients who had undergone a right sided valve replacement between October 1986 and September 1992 at Seoul National University Children뭩 Hospital.
Results
: Twenty six children underwent 27 mechanical valve replacement (tricuspid in 7; pulmonary in 20). Overall, 17(63.0%) out of 27 developed valve dysfunction. It occurred in 6(85.7%) of 7 in the tricuspid position, 26.17+24.51 months after replacement and in 11(55.0%) of 20 in the pulmonary position, 11.64+9.28 months after replacement. The main presenting symptoms were dyspnea in 5 (3 tricuspid, 2 pulmonary), facial edema in 1; the others were asymptomatic. Concurrent auscultatory findings were: disappeared valve click in 16, new diastolic murmur in 7, and increased systolic ejection murmur in 1. In all cases, low level of anticoagulation (INR < 2.0) was maintained by coumadin, with or without antiplatelet drugs. Among valve dysfunction cases, thrombloytic therapy with urokinase was attempted in 5 and reoperation in 7. Of 5 thrombolytic trial, treatment was successful in 3 and failed in 1. One died of severe right heart failure 4 hours after urokinase infusion. Operative procedure were valve replacement in 6 (another mechanical valve in 2, tissue valve in 4) and right ventricular outflow tract widening without valve insertion in 1. During the following up without specific treatment in remaining cases, all were asymptomatic. Valve click restored spontaneously in 3 cases 5 to 17 months after disappearance of click.
Conclusion
: The replacement with mechanical valve in the right side of the heart in children is associated with high incidence of dysfunction and should be avoided as possible as can be. Although thrombolytic therapy is effective in the treatment of mechanical valve thrombosis, close monitoring is needed to avoid complications. It is uncertain that asymptomatic valve dysfunction in the pulmonary position should always be treated to restore normal valve function.
Key Words: Mechanical valve dysfunction, Tricuspid, Pulmonary, Thrombolytic therapy


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