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Repairing the rheumatic mitral valve in the young: The horizon revisited

Chandrasekaran Ananthanarayanan1, Amber Malhotra1, Sumbul Siddiqui1

  • 1Department of Cardiovascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, BJ Medical College, Ahmedabad, India.

JTCVS Open
|August 25, 2022
PubMed

Insights

Rheumatic mitral valve repair in children is highly successful, with excellent midterm outcomes. This study shows young patients benefit from timely surgical intervention, achieving good functional status and survival rates.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Rheumatic Heart Disease

Background:

  • Rheumatic mitral valve disease predominantly affects older populations.
  • Limited data exists on surgical repair outcomes in pediatric patients with rheumatic mitral valve disease.

Purpose of the Study:

  • To evaluate the midterm results of mitral valve repair in young patients with rheumatic heart disease.
  • To assess the safety and efficacy of surgical techniques in this specific demographic.

Main Methods:

  • A retrospective-prospective study included 106 children (<18 years) undergoing mitral valve repair for rheumatic etiology between 2013-2017.
  • Patients underwent various repair techniques including annuloplasty, chordal procedures, and autologous pericardial augmentation.
  • Comprehensive follow-up was conducted with a mean duration of 25.6 months.

Main Results:

  • Operative mortality was low (1%). At midterm follow-up, 94.8% of patients were in New York Heart Association class I.
  • Excellent functional outcomes were observed with mean mitral regurgitation grade of 1.2 and mean gradient of 2.96.
  • Actuarial survival and freedom from reoperation at 2.5 years were high (96.2% and 97.1%, respectively), with no thromboembolic events.

Conclusions:

  • Rheumatic mitral valves in children are amenable to successful surgical repair.
  • Surgeons must possess a comprehensive understanding of valvular apparatus lesions and diverse repair techniques for optimal outcomes.
  • Mitral valve repair in pediatric rheumatic heart disease offers favorable midterm results and durable functional improvement.
Abstract

Keywords:
ABB, AbbreviationAML, anterior mitral leafletMR, mitral regurgitationNYHA, New York Heart AssociationPML, posterior mitral leafletannuloplastycommissurotomyleaflet augmentationmitralneochordspediatricrheumaticvalve repair

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