Ka. Aljubair et al., REPAIR OF THE MITRAL-VALVE BECAUSE OF PURE RHEUMATIC MITRAL VALVAR INCOMPETENCE IN THE YOUNG, Cardiology in the young, 8(1), 1998, pp. 90-93
Between January 1985 and April 1994, 42 children aged between 7 and 14
years (mean 11.3 years) underwent repair of severely incompetent rheu
matic mitral valves with no accompanying mitral stenosis. In 19 patien
ts the tricuspid valve was severely incompetent, while 8 patients had
severe aortic incompetence. Overall, the repair incorporated shortenin
g of elongated tendinous cords and insertion of a Duran or Carpentier
prosthetic ring. The repair was the sole procedure in 15 patients, whi
lst 19 patients also had a De Vega tricuspid valvar annuloplasty and 8
had repair or replacement of the aortic valve. There were no hospital
deaths. Postoperative transthoracic echocardiographic studies reveale
d trivial residual mitral valvar regurgitation in 6 patients, mild reg
urgitation in 18, moderate in 15, and regurgitation severe enough to w
arrant replacement of the mitral valve in 3 patients. The mean follow-
up period was 37 months (maximum 120 months, minimum 1 month). Of 39 p
atients followed-up, 28 attended for more than 5 years. Of these, 7 un
derwent replacement of the mitral valve for severe regurgitation withi
n 4 years of the repair. Severe mitral regurgitation in 3 patients was
controlled by medical therapy. One was eventually lost to follow-up.
and one patient died of causes unrelated to surgery. The remaining 16
patients had absent to moderate mitral valvar regurgitation. These res
ults contrast with 10 repairs of congenital mitral incompetence, where
no patients required re-operation in the immediate 5 years period of
follow-up. Every effort should be made in children with rheumatic mitr
al incompetence to preserve the natural valve by conservative repair,
despite the fact that repair of the incompetent rheumatic mitral valve
is not so durable as repair of congenitally incompetent valves.