REPAIR OF THE MITRAL-VALVE BECAUSE OF PURE RHEUMATIC MITRAL VALVAR INCOMPETENCE IN THE YOUNG

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.