Results of mitral valve reconstruction in children with rheumatic heart disease

Kumar, Arkalgud Sampath; Rao, Pantula Narasinga; Saxena, Anitá

doi:10.1016/0003-4975(95)00486-5

Cited by 28 publications

(24 citation statements)

References 10 publications

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“…As time passes and inflammation or scarring occurs during the chronic phase, mitral stenosis becomes more predominant for older RHD patients, 16) as we observed in our study and has been reported in another study 17) which revealed that the number of pure mitral regurgitation cases declined with increasing age. This ongoing activity and complicated valvular pathology may make mitral repair more difficult and have a less favorable outcome postoperatively, 7,18) as in our results with significantly greater residual or recurrent mitral stenosis occurring in our repair group than was the case for the replacement group. In addition, freedom from the need for repeat mitral surgery at 5 years postsurgery was 0.91 for the repair group, a result which was quite consistent with the results of several other studies, 5,7,10) but significantly greater than the corresponding figure for the mitral replacement group.…”

Section: Discussionmentioning

confidence: 52%

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

et al. 2008

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SUMMARYMitral repair is feasible for patients with degenerative or ischemic heart disease, however, the appropriateness of repair for rheumatic heart disease remains controversial. We compared our outcomes for primary isolated mitral repair versus replacement in an elderly population. From November 1997 to July 2005, mitral repair (group I) was performed in 33 patients while 59 underwent replacement (group II). Survival and risk factors were evaluated by Kaplan-Meier and Cox regression analysis. Mean age at operation for groups I and II was 49.7 ± 13.2 versus 58.1 ± 11.2 (P = 0.002). No statistically significant differences with regards to demographic parameters were observed except for there being fewer percutaneous transvenous mitral commissurotomy procedures and a lower severity of pulmonary hypertension in group I. Patients with a greater Wilkins score and more valvular calcification underwent replacement more often (P < 0.001). In-hospital mortality, ICU/hospital stay, and postoperative congestive heart failure functional class did not differ significantly. Major adverse cardiac events occurred in 13 and 19 patients, respectively (P = 0.50). There were 4 versus 6 late deaths (P = 0.74). Only two from group I underwent subsequent mitral reoperation. Kaplan-Meier overall survival and event-free survival at 5 years for groups I and II were 0.81 ± 0.08 versus 0.81 ± 0.06 (P = 0.90) and 0.52 ± 0.10 versus 0.51 ± 0.10 (P = 0.21), respectively. Old age, renal insufficiency, LVEF < 40%, and a history of stroke were poor predictors of patient survival. Compared with replacement, mitral repair for rheumatic heart disease was associated with a lower surgical mortality, higher repeat-surgery rate, and good survival. Rheumatic mitral valves should be repaired in select patients with appropriate valvular pathology. (Int Heart J 2008; 49: 565-576)

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Section: Discussionmentioning

confidence: 52%

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

et al. 2008

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“…The three patients who died were in functional class IV, and two of them were in the acute phase of the disease. This mortality rate may be considered high if compared with those of most of the authors, which range from 0 to 4.8% [17][18][19][20] . Carpentier reported his 10-year experience with repair, with an in-hospital mortality of 4.2% in adults and children 14 .…”

Section: Discussionmentioning

confidence: 74%

“…Surgical mortality is higher in the acute phase of rheumatic feverwhen operation is indicated in patients with severe valve dysfunction and ineffective clinical treatment. Even in this group, repair may provide better results than valve replacement, as it preserves the whole subvalvular apparatus, which results in better postoperative ventricular function 12,19 .…”

Section: Discussionmentioning

confidence: 99%

Plastia mitral cirúrgica em crianças com febre reumática

Silva¹,

Herdy²,

Vieira³

et al. 2009

Arq. Bras. Cardiol.

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“…Perbaikan katup merupakan prosedur pilihan pada anak sebab penggantian katup mempunyai angka kematian yang lebih tinggi dibandingkan dengan dewasa. Hasil operasi berkaitan dengan masalah ukuran pada katup pengganti, pemberian antikoagulan jangka panjang, degenerasi bioprostesis lebih cepat terjadi, risiko tinggi terjadi endokarditis, penurunan fungsi ventrikel, dan penurunan angka harapan hidup, [13][14][15][16][17][18] Perbaikan katup mempunyai angka kegagalan yang lebih tinggi dan secara teknis lebih sulit dibandingkan dengan penggantian katup karena kelainan yang lebih kompleks seperti deformitas daun katup, kombinasi kelainan stenosis dan regurgitasi serta keterbatasan pergerakan katup, sehingga meningkatkan frekuensi re-operasi. Selain itu penilaian pascareparasi juga lebih sulit dan serangan ulang demam reumatik membuat hasil reparasi juga kurang stabil.…”

Section: Pembahasanunclassified

“…Selain itu penilaian pascareparasi juga lebih sulit dan serangan ulang demam reumatik membuat hasil reparasi juga kurang stabil. 15,16,18 Hasil penggantian katup pada anak tidak sebaik reparasi dengan angka kematian 19%, sehingga reparasi merupakan pilihan pada anak, namun perbaikan katup secara teknis lebih sulit dan dihubungkan dengan angka kegagalan yang tinggi pada anak.…”

Section: Pembahasanunclassified

Profil Klinis dan Keluaran Penyakit Jantung Reumatik pada Anak yang Menjalani Bedah Katup

Kuswiyanto

Putra

Advani

et al. 2016

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Latar belakang. Penyakit jantung reumatik merupakan kelainan jantung didapat penyebab kesakitan dan kematian terbanyak pada anak di Indonesia. Bedah katup pada anak dengan penyakit jantung reumatik jarang dilakukan. Tujuan. Untuk mengetahui profil klinis dan keluaran bedah katup pada anak dengan penyakit jantung reumatik. Metode. Penelitian secara retrospektif dilakukan pada 28 anak dengan penyakit jantung reumatik yang menjalani bedah katup di RSUPN Cipto Mangunkusumo selama tahun 2003 sampai 2009. Data dikumpulkan dan dicatat berdasarkan catatan medis berupa profil klinis sebelum operasi, umur saat operasi, jenis kelamin, status klinis, dan jenis operasi, serta data ekokardiografi berupa kelainan katup dan fungsi ventrikel. Sedangkan keluaran berupa komplikasi pascaoperasi, lesi residual dan fraksi ejeksi, fraksi pemendekan serta dimensi akhir diastolik ventrikel kiri seminggu pascaoperasi. Hasil. Umur rerata saat operasi 13,9 (SD 2,7) tahun; anak laki-laki dan perempuan sama banyak. Status klinis praoperatif fungsional kelas III dan kelas IV masing-masing terjadi pada 13 dan 9 anak. Regurgitasi mitral berat didapatkan pada 75% anak. Perbaikan katup mitral dilakukan pada 16, penggantian katup mitral pada 8, dan penggunaan katup ganda pada 4 anak. Tiga anak mengalami komplikasi berupa perdarahan, efusi pleura, dan sepsis, sedangkan satu orang meninggal. Lesi residual pascaoperasi didapatkan pada 11 anak, berupa regurgitasi dan stenosis mitral ringan, dan satu anak dengan paravalvular leak. Tidak didapatkan perbedaan yang bermakna dalam fraksi ejeksi, fraksi pemendekan dan dimensi akhir diastolik ventrikel kiri sebelum dan seminggu sesudah operasi. Kesimpulan. Bedah katup pada anak dengan penyakit jantung reumatik mempunyai keluaran yang baik, dengan angka kematian dan komplikasi yang rendah. Pemantauan lebih lanjut diperlukan untuk menilai keluaran jangka panjang. Sari Pediatri 2011;13(3):200-6. Kata kunci: bedah katup, penyakit jantung reumatik pada anak

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Results of mitral valve reconstruction in children with rheumatic heart disease

Cited by 28 publications

References 10 publications

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

Midterm Outcomes of Rheumatic Mitral Repair Versus Replacement

Plastia mitral cirúrgica em crianças com febre reumática

Profil Klinis dan Keluaran Penyakit Jantung Reumatik pada Anak yang Menjalani Bedah Katup

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