An overview of artificial heart valve replacement in infants and children
Tong, E.
Journal of Cardiovascular Nursing 6(3): 30-43
1992
ISSN/ISBN: 0889-4655 PMID: 1556584 DOI: 10.1097/00005082-199204000-00004Document Number: 322559
Abnormal embryologic development and inflammatory or degenerative diseases cause valvular heart disease in children. Physicians consider children's age, size, pathology and natural history of the disease, size and anatomy of cardiac chambers and great vessels, and success of past interventions when deciding on valve replacement. The 1st treatment tends to be preservation and reconstruction of the natural valve. It is difficult to obtain a prosthetic valve of adequate size. Because the child is growing quickly the prosthetic valve, quickly becomes too small an hemodynamically restrictive. A prosthetic valve increases the risk of infection. The 3 main types of prosthetic valves are bioprosthetic, mechanical, and allograft valves. Management issues of a child undergoing heart valve replacement surgery include thromboembolism, minimalizing blood coagulation without undue bleeding, endocarditis, and pregnancy. More and more females with prosthetic heart valves are achieving reproductive years. Women with adequately efficient valves and are in the American Heart Association class I or II face a much better likelihood of a successful pregnancy and fetal outcome than those in class III or IV. Indeed women of class III or IV regardless of the conditions of the valve should not become pregnant until their status has been upgraded. Pregnancy risks include ability of the heart to maintain cardiac output and stroke volume and teratogenic effects of sodium warfarin on the fetus. Pregnant patients can receive subcutaneous heparin therapy, however. Nurses can play a leading role in counseling parents of heart valve replacement children. For example, they can educate them and their affected children about contraception while they are in their early teens. Specifically they need to counsel them about the risks of pregnancy and of using estrogen-based contraceptives and IUDs. Diaphragms and condoms along with a spermicide are the best methods for heart valve replacement females.