Heart Valve Repair in Children

With improvements in the management of complex congenital heart disease and in valve repair techniques, infants and children are increasingly being referred for valve repair. Surgical management of heart valve disease in children must take into account the specificities of this patient population: (1) the very long expected survival and durability of a repair, (2) allow for growth of the patient, (3) implants calcify much quicker in children, (4) mechanical heart valves and their anticoagulation carry a prohibitive risk of thrombo-embolism and bleeding, as well as panus formation. The present thesis reviews recent advances in valve repair in children, which avoids anticoagulation and its complications and improves survival. Aortic cusp extension valvuloplasty has excellent long-term freedom from reoperation or significant aortic valve regurgitation, although failure is mainly linked to extension patch materials. Mitral and tricuspid valve operations are feasible with good long-term clinical outcomes. Annuloplasty with a biodegradable annuloplasty ring, implanted intra-annularly, provides durable remodeling of the mitral and tricuspid annulus, while allowing for growth in children. Leaflet tethering is an important mechanism of regurgitation in children, and both leaflet suspension and right ventricular papillary muscle to the ventricular septum have been shown to be safe and effective as an additional tool in the surgical armamentarium. Multiple valve repair is feasible with good early- and mid-term results, although this is only a palliative approach to delay valve replacement. Using the techniques describes above to relieve inflow (mitral) and outflow (aortic) obstruction, as well as resection of endocardial fibro-elastosis and restriction of the atrial septal communication, it is feasible to bring selected patients with hypoplastic left heart syndrome to a biventricular repair with excellent results. These strategies will help improve the long-term outcomes for children with heart valve disease