[Reconstructive surgery of rheumatic mitral valvulopathy in patients under 18 years of age].

OBJECTIVE

To present our experience in 58 children (37 female, 21 male) aged 4 to 18 years (mean +/- SD = 14.9 +/- 2.7) with rheumatic mitral valve disease who underwent surgical reconstruction.

METHODS

They were divided in four groups according to the abnormalities of the mitral apparatus: Group I had mitral regurgitation due to lesions located in the valvar structures with normal valvar movement (n = 1, 2%), group II mitral regurgitation with lesions located mainly in subvalvular structures with valve prolapse (n = 11, 19%), group III with mitral regurgitation due to lesion located both in valvular and subvalvular structures and restricted valvar motion (n = 38, 65%), and group IV included patients with stenosis (n = 8, 14%).

RESULTS

Surgical mortality was 5% (3/58) and three patients (5%) were reoperated immediately. The 52 remaining patients were followed from 6 to 108 months (mean 45.8 +/- 30.1 months, 199 patient-years). Six cases were reoperated in the follow-up (3.0% per patient-year). The functional class using the criteria of the New York Heart Association was evaluated before and after the procedure: class I raised from two to 42 patients whereas it decreased in the others (class II from 13 to 7, class III from 38 to 3, class IV from 5 to none; p < 0.001). The cardiothoracic index decreased from 0.61 +/- 0.064 before surgery to 0.55 +/- 0.069 after surgery (p < 0.001). Thirty patients (57%) were evaluated with echo-Doppler in the follow-up period. There were no deaths in the follow-up period.

CONCLUSIONS

Our data shows that reconstructive surgery of the mitral valve with rheumatic involvement offers good immediate and late results, with a low reoperation rate, avoiding the use of prosthetic valves as a first option.