Triple-valve operation in the young rheumatic patient

Multiple-valve operation for the young rheumatic patient remains a problem. There is a paucity of information on the results of repair versus replacement in this age group. Between July 1988 and December 1991, 242 patients less than 20 years of age underwent a valve operation for rheumatic heart disease at our institution. Twenty-four (9.9%) of them had simultaneous mitral, aortic, and tricuspid valve procedures. The mean age was 14.71 years. All 24 patients were in functional class III or IV preoperatively. Valvar regurgitation was the predominant lesion. Four patients (16.7%) had active rheumatic myocarditis at the time of operation. Valve repair was attempted in the absence of infective endocarditis. Triple-valve repair was possible in 12 patients (50%). The hospital mortality rate was 16.7%. Reoperation was performed after repair in 9 patients (45%) without any deaths. The reason for reoperation was failure of the mitral valve repair in all patients, and the cause was technical in 3 patients, progression or recurrence of rheumatic myocarditis in 5, and endocarditis in 1 patient. The three late deaths (15%) were in patients who had mitral valve replacement. Valve repair was associated with a higher reoperation rate, and replacement of left-sided valves was associated with a higher early and late mortality. In conclusion, although valve repair would be ideal in the young rheumatic patient, multiple-valve repair is associated with a high reoperation rate.