Pediatric Mitral Valve Replacement

[Bob__0__0]

  I have a child under the age of two years who needs to have her mitral valve replaced.  I have the following questions:
  1. About how long will the valve last before the child out-grows the replacement valve?
  2. I have heard of a procedure where cloned tissue is placed over a mold so
  that the "artificial valve" will grow with the body.  Is this still experimental? where is it
  being performed?  What are the results?
  
  3. What types of medications/special conditions will the child encounter
  as she grows?
  4. How will the surgery affect appetite? - she has a feeding tube now and takes nothing by mouth.
  5. How will it affect acitiity? - she's just starting to walk & talk; will there be setbacks?

[CCF Cardio MD - MTR]

_
Dear Bob, thank you for your question.  You ask a number of difficult questions, so I'll try to answer them as best as I can.  Children who need a mitral valve replacement commonly receive a mechanical valve made of polymers/metals that are very durable. With a mechanical valve, blood thinners (coumadin) need to be taken chronically to prevent clots from forming on the valve surfaces.  In a two year old child, the valve would be expected to be replaced at least one time later in life as she grows and the mechanical valve becomes too small.  Usually, this occurs in the teenage years but I cannot give you a specific answer to this question with the information that I have.  There are no alternative valve replacements that I could find in my research to answer this question.  I could find no information on cloning valve tissue as you describe.  For pediatric patients who need an aortic valve replacement, the pulmonic valve can be switched to the aortic position where it will keep growing and the pulmonic valve is replaced with a cadaveric homograft - the so-called Ross Procedure.  No similar procedure exists for the mitral valve, unfortunately.  In addition to the blood thinner (coumadin), your daughter may need to be on other cardiac medications as dictated by her cardiologist, and would need to take antibiotics to prevent infection of the artificial valve for any dental work or other invasive procedures.  Since she will be on blood thinners, she would need to be restricted in her activities to avoid falls and cuts which could be more problematic with an increased tendency to bleed.  Whether her appetite and activity level will increase after mitral valve replacement depends upon her underlying cardiac malformation, her current functional level, and her current nutritional status.  Her pediatric cardiologist is better equipped to answer those questions than I am.  I hope you find this information useful, but you certainly should ask these same questions to her pediatric cardiologist and the cardiac surgeon who will perform her valve replacement.  Information provided in the heart forum is for general purposes only.  Specific diagnoses and therapies can only be provided by your physician.