Ngardig Ngaba Neguemadji, Chibuzo Uzoego Nwakaku, Patel Meet, Gulati Amit, Ola Olatunde, Djindimadje Allarangué, Khan Imteyaz A
CHU Bon Samaritain de Walia, N'Djamena, Chad.
Department of Pediatrics, Jamaica Hospital Medical Center, New York, NY, United States.
Front Cardiovasc Med. 2022 Dec 15;9:978874. doi: 10.3389/fcvm.2022.978874. eCollection 2022.
Mitral stenosis (MS) is a widely known complication of mitral valve repair for non-rheumatic mitral regurgitation (MR). Few reports are available on the occurrence of MS after mitral valve repair for rheumatic MR in young populations.
A 14-year-old girl presented with orthopnea, abdominal distension, and bilateral lower-limb edema. She was cachectic, with a high-pitched holosystolic murmur best heard at the cardiac apex, bilateral basal crackles, tender hepatomegaly, pitting pedal edema, and jugular venous distension. Antistreptolysin O (ASO) titer was elevated. Transthoracic echocardiography (TTE) revealed the loss of central coaptation of the mitral valve with leaflet restriction and MR, annular dilatation of the tricuspid valve, and tricuspid regurgitation (TR). She had AHA/ACC stage D mitral and TR s. Tricuspid annuloplasty and mitral valve repair for rheumatic MR were performed using Carpentier Edwards numbers 30 and 34, respectively. Following surgery, the weight and body mass index (BMI) rapidly normalized. The patient also developed progressive MS.
Previous studies in adults have described the etiopathogenesis of MS after non-rheumatic mitral valve repair. There is a paucity of reports describing the development of MS over the span of months after rheumatic MR valve repair in early pubescent children.
Growth spurts during puberty can potentially affect MR repair, as the mitral valve prosthesis based on the preoperative Body Surface Area (BSA) is outgrown. There is a need for research on planning, prognostication, and development of an optimal, individualized, and adaptable approach to MR intervention in early pubescence.
二尖瓣狭窄（MS）是已知的非风湿性二尖瓣反流（MR）二尖瓣修复术后的并发症。关于年轻人群风湿性MR二尖瓣修复术后发生MS的报道很少。
一名14岁女孩出现端坐呼吸、腹胀和双侧下肢水肿。她消瘦，在心尖部可闻及最响亮的高调全收缩期杂音，双侧肺底湿啰音，肝脏肿大压痛，足背凹陷性水肿，颈静脉怒张。抗链球菌溶血素O（ASO）滴度升高。经胸超声心动图（TTE）显示二尖瓣中央对合消失，瓣叶受限和MR，三尖瓣环扩张，三尖瓣反流（TR）。她处于美国心脏协会/美国心脏病学会D期二尖瓣和TR。分别使用Carpentier Edwards 30号和34号人工瓣膜对风湿性MR进行三尖瓣环成形术和二尖瓣修复。术后，体重和体重指数（BMI）迅速恢复正常。患者还出现了进行性MS。
先前针对成人的研究描述了非风湿性二尖瓣修复术后MS的发病机制。关于青春期前儿童风湿性MR瓣膜修复术后数月内MS发展的报道很少。
青春期的生长突增可能会影响MR修复，因为基于术前体表面积（BSA）的二尖瓣假体不再适用。需要开展关于青春期早期MR干预的规划、预后及制定最佳、个性化和适应性方法的研究。
