[Mitral valve prosthesis without anticoagulant treatment. Apropos of 46 cases]

Out of a total of 90 patients with valvular prosthesis not treated with anti-coagulants, 46 only had a prosthesis in the mitral position. These patients were treated in Professor Ben Ismail's department for an average of 58 months (extreme limits 26 and 116 months). The average age of these patients at the time of the operation was 13.6 years. It is important to note that these patients greatly improved as attested to by the evolution of the functional symptoms, cardiac volume, capillary and pulmonary arterial pressure. 7 patients had a thromboembolism (15.5 per cent or 3 embolisms per 100 patient-years). Three cases were minor or rapidly regressed and out of four major cases, one died. This complication is much more frequent in patients treated with anti-coagulants as is the risk of haemorrhage which is sometimes serious or even mortal. In view of these results, it seems legitimate, in these young patients, especially when they are in sino-astrial rhythm, have a good clinical history and are haemodynamic to forego anti-coagulant treatment which may be dangerous in these undisciplined patients under irregular and unusual treatment.