Prosthetic valves

Many challenges are faced by pediatric patients and their surgeons in finding acceptable replacement heart valves for diseased, diminutive, or absent native valves. One of the primary challenges is valve size. Many prosthetic valves available in the market today are applicable only to the largest of pediatric patients. Even the smallest of commercially available valves can have unacceptable gradients. This can, at times, be circumvented by various surgical techniques, annular enlargement, or valve positioning. Other obstacles faced in this patient population include the issues of somatic growth, valve calcification, structural deterioration, thromboembolism, and the need for anticoagulation and its associated monitoring requirements. This chapter reviews the currently available prosthetic valves, valve choice for various locations and indications in the pediatric patient, and lastly, management and complications of prosthetic valve placement in children.