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[Reconstructive surgery of rheumatic mitral valvulopathy in patients under 18 years of age]
A Buendía-Hernández1, F Attié, C Zabal
1Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
Insights
Surgical reconstruction of rheumatic mitral valve disease in children yields excellent outcomes, with a low reoperation rate and improved heart function, making it a preferred initial treatment over prosthetic valves.
Area of Science:
- Cardiology
- Pediatric Surgery
- Rheumatic Heart Disease
Context:
- Rheumatic mitral valve disease (RMVD) is a significant cause of morbidity in children.
- Surgical intervention is often necessary to manage severe RMVD.
- Previous studies have focused on prosthetic valve replacement, with limited data on reconstructive outcomes in pediatric populations.
Purpose:
- To evaluate the efficacy and safety of surgical mitral valve reconstruction in pediatric patients with RMVD.
- To analyze short-term and long-term outcomes, including reoperation rates and functional status.
- To compare reconstructive surgery outcomes with prosthetic valve use as a primary option.
Summary:
- This study presents the surgical experience with mitral valve reconstruction in 58 children (aged 4-18 years) diagnosed with RMVD.
- Patients were categorized into four groups based on the specific mitral valve abnormalities.
- Surgical mortality was 5%, with significant improvements in New York Heart Association functional class (p < 0.001) and cardiothoracic index (p < 0.001) post-reconstruction.
Impact:
- Reconstructive surgery for RMVD in children demonstrates favorable immediate and long-term results.
- The procedure offers a low reoperation rate, suggesting durability and effectiveness.
- Mitral valve reconstruction should be considered the primary surgical approach for RMVD in pediatric patients, potentially avoiding prosthetic valve implantation.
Objective:
To present our experience in 58 children (37 female, 21 male) aged 4 to 18 years (mean +/- SD = 14.9 +/- 2.7) with rheumatic mitral valve disease who underwent surgical reconstruction.
Methods:
They were divided in four groups according to the abnormalities of the mitral apparatus: Group I had mitral regurgitation due to lesions located in the valvar structures with normal valvar movement (n = 1, 2%), group II mitral regurgitation with lesions located mainly in subvalvular structures with valve prolapse (n = 11, 19%), group III with mitral regurgitation due to lesion located both in valvular and subvalvular structures and restricted valvar motion (n = 38, 65%), and group IV included patients with stenosis (n = 8, 14%).
Results:
Surgical mortality was 5% (3/58) and three patients (5%) were reoperated immediately. The 52 remaining patients were followed from 6 to 108 months (mean 45.8 +/- 30.1 months, 199 patient-years). Six cases were reoperated in the follow-up (3.0% per patient-year). The functional class using the criteria of the New York Heart Association was evaluated before and after the procedure: class I raised from two to 42 patients whereas it decreased in the others (class II from 13 to 7, class III from 38 to 3, class IV from 5 to none; p < 0.001). The cardiothoracic index decreased from 0.61 +/- 0.064 before surgery to 0.55 +/- 0.069 after surgery (p < 0.001). Thirty patients (57%) were evaluated with echo-Doppler in the follow-up period. There were no deaths in the follow-up period.
Conclusions:
Our data shows that reconstructive surgery of the mitral valve with rheumatic involvement offers good immediate and late results, with a low reoperation rate, avoiding the use of prosthetic valves as a first option.