Thromboembolic Complications in Pediatric Patients Undergoing Valve Replacement with the St. Jude Medical® Prosthesis
Our experience over a 16-year period of valve replacements in the pediatric age group totals 61 patients. Initially, bioprosthetic valves were used, but a high incidence of early degeneration of porcine and calf pericardial valves necessitated a change. With the evolution of low-profile prosthetic valves of better hydraulic performance, early mortality and morbidity have fallen significantly. Seventeen valve replacements have been performed over the last 5 years in patients under 16 years of age. Eleven were in the mitral position, 2 in the tricuspid position, and 3 in the aortic position. Early in the series, an elective decision was made to not routinely use anticoagulants. However, 3 patients have suffered major thromboembolic complications: 1 thrombosed valve in the tricuspid position in a 7-year-old child, 1 major cerebral embolus in a 15-year-old child with a mitral prosthesis, and a thrombosed mitral prosthesis in a 2-year-old child who survived emergency reoperation. There were 2 further instances of thromboembolism in 2 other children. This experience determined a change in policy, reinstituting the use of anticoagulants.
KeywordsValve Replacement Jude Medical Mitral Valve Disease Bioprosthetic Valve Heart Valve Replacement
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