Emergency valve replacement in rheumatic heart disease

Emergency valve replacement is defined as surgery undertaken to correct valvular heart disease which otherwise would have proved fatal within 24 h.

Among 1,742 patients who underwent valve replacement during the past 15 years at the authors' institution, 61 who had emergency surgery formed two groups. Group 1 (n = 24) had a previous good circulatory status but suffered a sudden change in valvular function, in the initial period after closed mitral valvotomy (CMV), and in later years after balloon aortic valvotomy (BAV) or balloon mitral valvotomy (BMV) for aortic or mitral valvular stenosis. Group 2 (n = 37) had chronic decompensated rheumatic valvular disease and acute low cardiac output.

Four deaths occurred in group 1 (17%) during the early stage of the study, but no deaths have occurred during the past five years. Mean follow up was 13.5 months (range: 5-30 months). Among 20 survivors, 14 were in NYHA class I, and six in class II. Ten deaths occurred in group 2 (27%), including two during the past eight years among patients who had surgery. Mean follow up was 37.7 months (range: 8-96 months). Among 27 survivors, 11 were in NYHA class I, 12 in class II, two in class III and two in class IV.

In this potential terminally ill group of patients, surgery offers the only option for survival.