Mitral valve surgery in children.

Area of Science:

• Cardiology
• Pediatric Surgery
• Rheumatic Heart Disease

Background:

• Rheumatic mitral valve disease significantly impacts pediatric patients, often requiring surgical intervention.
• Patients aged 15 or younger with severe mitral stenosis or regurgitation present unique surgical challenges.

Purpose of the Study:

• To evaluate the long-term outcomes of surgical treatments for rheumatic mitral stenosis and regurgitation in pediatric patients.
• To assess the efficacy and safety of closed mitral commissurotomy and valve replacement/reconstruction in this population.

Main Methods:

• Retrospective analysis of 113 pediatric patients (5-15 years) operated on between 1968 and 1985 for rheumatic mitral valve disease.
• Seventy-two patients underwent closed mitral commissurotomy for stenosis; 40 patients had valve replacement or reconstruction for regurgitation.

Main Results:

• Closed mitral commissurotomy resulted in 2.7% mortality, with 83.5% excellent outcomes, but 23.0% experienced restenosis over 15 years.
• Mitral valve replacement/reconstruction had a 10.0% mortality, with 80.0% excellent outcomes; three patients had minor embolization.
• All survivors achieved independence in daily living and normal growth patterns.

Conclusions:

• Surgical management of rheumatic mitral valve disease in children can lead to excellent functional recovery and normal growth.
• While effective, long-term surveillance is crucial due to risks of restenosis and embolic events, particularly after commissurotomy.