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[Conservative surgery of rheumatic mitral insufficiency in children. Remote results]
J P Girardet1, P Challier, U Hvass
1Clinique de Pédiatrie, Hôpital Trousseau, Paris.
Insights
Mitral valvuloplasty in children with rheumatic mitral incompetence showed a 4-year survival rate of 93.8%. Surgical technique and pre-operative ventricular function influenced long-term outcomes, with 76.1% avoiding reoperation.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Rheumatic Heart Disease
Context:
- Rheumatic heart disease remains a significant cause of acquired heart disease in children globally.
- Mitral valve incompetence in pediatric patients necessitates effective surgical interventions.
- Limited data exists on the long-term outcomes of mitral valvuloplasty in pediatric populations with rheumatic etiology.
Purpose:
- To evaluate the efficacy and long-term results of mitral valvuloplasty in children with symptomatic mitral valve incompetence of rheumatic origin.
- To identify factors correlating with successful surgical outcomes and reoperation rates.
Summary:
- This study analyzed 38 children (aged 3.8-16.4 years) who underwent mitral valvuloplasty between 1977 and 1986.
- Immediate post-operative mortality was 5.3%, with 6 patients lost to follow-up.
- Among 30 children followed for a mean of 3.3 years, 4-year survival was 93.8%, and survival without reoperation was 76.1%.
- Factors influencing outcomes included pre-operative left ventricular myocardial function and surgical technique, specifically the use of annuloplasty.
Impact:
- Mitral valvuloplasty can be a viable option for pediatric mitral valve incompetence, but careful patient selection and surgical technique are crucial.
- Understanding prognostic factors can guide surgical decision-making and improve patient management.
- This research contributes to the evidence base for managing rheumatic heart disease in children.
Abstract:
Between 1977 and 1986, 38 children aged from 3.8 to 16.4 years underwent mitral valvuloplasty for symptomatic mitral valve incompetence of rheumatic origin. Two children (5.3 per cent) died in the immediate post-operative period, and 6 were lost sight of. Among the 30 children followed up for a mean period of 3.3 years, 6 were reoperated upon within 5 months of the valvuloplasty, 5 still present with a significant residual mitral valve incompetence and 9 have satisfactory clinical and echocardiographic results. Survival rate and survival rate without reoperation at 4 years were 93.8 per cent and 76.1 per cent respectively. Factors that correlated with the quality of long-term results were pre-operative left ventricular myocardial fibre shortening rate and surgical technique (poor results were obtained in children who had only one annuloplasty or none).