Repair of the mitral valve because of pure rheumatic mitral valvar incompetence in the young

Abstract

Between January 1985 and April 1994, 42 children aged between 7 and 14 years (mean 11.3 years) underwent repair of severely incompetent rheumatic mitral valves with no accompanying mitral stenosis. In 19 patients the tricuspid valve was severely incompetent, while 8 patients had severe aortic incompetence. Overall, the repair incorporated shortening of elongated tendinous cords and insertion of a Duran or Carpentier prosthetic ring. The repair was the sole procedure in 15 patients, whilst 19 patients also had a De Vega tricuspid valvar annuloplasty and 8 had repair or replacement of the aortic valve. There were no hospital deaths. Postoperative transthoracic echocardiographic studies revealed trivial residual mitral valvar regurgitation in 6 patients, mild regurgitation in 18, moderate in 15, and regurgitation severe enough to warrant replacement of the mitral valve in 3 patients. The mean follow-up period was 37 months (maximum 120 months, minimum 1 month). Of 39 patients followed-up, 28 attended for more than 5 years. Of these, 7 underwent replacement of the mitral valve for severe regurgitation within 4 years of the repair. Severe mitral regurgitation in 3 patients was controlled by medical therapy. One was eventually lost to follow-up, and one patient died of causes unrelated to surgery. The remaining 16 patients had absent to moderate mitral valvar regurgitation. These results contrast with 10 repairs of congenital mitral incompetence, where no patients required re-operation in the immediate 5 years period of follow-up. Every effort should be made in children with rheumatic mitral incompetence to preserve the natural valve by conservative repair, despite the fact that repair of the incompetent rheumatic mitral valve is not so durable as repair of congenitally incompetent valves.

Comparison of Clinical and Echocardiographic Outcomes After Valve Repair: Degenerative Versus Rheumatic Mitral Regurgitation

“…Despite relatively early attempt of valve repair in rheumatic mitral regurgitation, higher rates of failure and late re-operation compared to the degenerative mitral regurgitation group made most physicians and surgeons believe that etiology plays an important role in the results of repair (9,10,14,16). Unlike the previous clinical reports, our study shows different results of valve repair for rheumatic mitral regurgitation.…”

“…In a few studies on predominant rheumatic mitral regurgitation, the mean age of the subjects was between 11 to 27 yr (14,15,18). Duran and other investigators reported that young age with high chance of active rheumatic carditis is an important predisposing factor of re-operation (7,8,13,14,16), which has been challenged recently by another group (18). The most important difference, we believe, is that all patients underwent preoperative echocardiographic screening for feasibility of repair surgery in our study.…”

“…However, not many reports on clinical outcomes are available and most available clinical data of repair in rheumatic pathology were based on mixed results of patients with both mitral stenosis and regurgitation; less than one-third had pure, predominant rheumatic mitral regurgitation (11)(12)(13). In a few reports of patients with pure rheumatic mitral regurgitation, the mean age of the subjects was less than 30 yr (14,15), and their conclusions remain to be reconfirmed in different patient population including higher mean age. Moreover, no use of routine preoperative echocardiographic screening, intraoperative monitoring and postoperative follow-up study in the previous studies might affect the assessment of the exact role of reconstructive procedures for rheumatic mitral regurgitation in recent days.…”

Long-Term (29 Years) Results of Reconstructive Surgery in Rheumatic Mitral Valve Insufficiency

“…Rheumatic disease is currently known to carry a high risk of reoperation [11][12][13] compared with degenerative disease. 4,12,14 However, the global rate of reoperation is 2% patients per year.…”

Plastia valvar mitral na doença cardíaca reumática e degeneração mixomatosa: estudo comparativo

“…O resultado da reconstrução mitral na doença cardíaca reumática varia na literatura, dependendo, provavelmente, do comportamento bioló-gico da doença nos diversos continentes, e da qualidade assistencial oferecida a essas populações (5)(6)(7)(8) .…”