Vaishnavi Kardale, Bioinformatics Centre, Savitribai Phule Pune University
‘Lub-Dub’ is the sound the heart makes every time it beats. It is probably one of the most easily recognizable sounds. The heart is one of the most essential organs in the body, pumping blood to all the parts of the body. It is required to transport gases, nutrients, and other essential components to all the tissues in our body.
A brief overview of heart:
The heart along with arteries and veins make up the circulatory system. The role of this system is to provide blood to all parts of the body. The heart is made up of cardiac muscle and is divided into four parts the upper two are atriums and the lower two are ventricles. The atrium is maintained at high pressure while the ventricles are maintained at a lower pressure. This pressure difference is crucial for proper pumping. The pressure is maintained by two valves. The left atrium and ventricle have oxygenated blood while the right atrium and ventricle have deoxygenated blood. The atrium and ventricle on both sides have valves to separate the compartments. The ‘lub-dub’ sound the heart makes is due to the opening and closing of these valves.
A study regarding the outcome of Mitral Valve Replacement:
The left atrium and the left ventricle are separated by the mitral valve. The left atrium receives oxygenated blood from the lungs which it empties in the left ventricle. The left ventricle then pumps the blood to the entire body through the pulmonary vein. The mitral valve closes and does not allow the blood from the left ventricle to flow back to the left atrium.
When the mitral valve does not close properly the blood can flow backward, this condition is called mitral regurgitation. In mitral stenosis, the valve becomes narrow, blocking the blood’s path while it is coming from the left atrium to the left ventricle. This puts the heart muscle under a lot of stress as they have to beat faster in order to provide for the oxygen to the body. In such conditions, doctors carry out mitral valve repair but if it is not feasible then mitral valve replacement (MVR) is suggested.
Not much data is available on MVR in children and infants. It has many limitations in children and is associated with a high mortality rate ranging from 10% to 36%. Data suggests that the mortality rate is even higher in children less than 2 years of age. After the MVR procedure anticoagulation therapy is started however long-term anticoagulation therapy is associated with increased morbidity in children. A recent study in Saudi Arabia was carried out to evaluate the outcome of MVR in children less than 5 years of age.
What did the study find?
MVR is challenging in children due to variable anatomy, growth in a child, the unavailability of valve sizes, and need for anticoagulating agents. According to a suggestion from Pluchinotta and colleagues, the positioning of stented bovine jugular vein graft in mitral position is safe, effective, and reproducible. Supra-annular valve position is another option to place a large-sized valve in children. In this study, no correlation was found between valve size, body surface area, or age. The observations seen in the patients who were subjects in the study are as follows:
- For 20% of the patients in this study, the researchers used the supra-annular valve position.
- For 66% of patients, the St. Jude valve was used.
- 17% of patients required pacemaker implantation.
This research did not find any significant effect of age, weight, and the risk of reoperation. Small valve type was associated with a high risk of reoperation.
The limitation to the study was a smaller sample size as MVR is not a very common procedure in infants and children. This limited statistical analysis. No generalization can yet be made from this study as it was a single-center experience. To fully understand the risk and complications of MVR on children, a multi-center study with a higher sample size needs to be carried out.
Also read: The Rarest Type of Blood In The World: Rh-null
Reference:
- Elmahrouk, A. F., Mashali, M. H., Ismail, M. F., Arafat, A. A., Alamri, R. M., Baho, H. A., Shihata, M. S., & Jamjoom, A. A. (2021). Mitral valve replacement in infants and younger children. Scientific Reports. Published. https://doi.org/10.1038/s41598-021-94779-0
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Author info:
Vaishnavi Kardale is a master’s student at the Bioinformatics Centre, Savitribai Phule University. She is interested in protein folding mechanisms and wants to study them further.
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