Objective: This study was carried out to evaluate the early surgical outcome of double valve (aortic and mitral) replacement (DVR) in children with rheumatic valve disease in Nepal.
Methods: Between 2002 and 2008 over 2000 valve replacements have been done in our institution. Of these 58 children under the age of 15 had undergone double valve replacement. Standard cardiopulmonary bypass techniques with mild hypothermia for perfusion and cold blood cardioplegia was used for myocardial protection. Bileaflet mechanical valves (St. Jude Medical ®, St Paul, MN, USA) were used to replace the valves.
Results: Average age of the children was 13.4 years. Indication for operation was heart failure despite medical therapy. Majority ( 87 %) of the children were in New York Heart Association (NYHA) functional class 3 or 4. Mean preoperative diastolic left ventricular internal dimension (LVIDd) in was 6.2 cm. Average x-clamp time was 92 minutes and CPB time was 127 minutes. Operative mortality was 2%. Most frequently implanted sizes were 19 hp for aortic and 27 mm for mitral position. Seventeen percent of the children underwent tricuspid valve repair also. At 3 months all surviving patients who completed follow up studies (n=30) had significantly lower average postoperative LVIDd at three months than at the time of surgery (4.5 cm vs 6.2 cm). All of them were at functional class 2 or less.
Conclusions: Double valve replacement in children with rheumatic disease has excellent early surgical outcome and may offer longer term palliation than repair.