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J Thorac Cardiovasc Surg 2005;129:875-879
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Mitral valve repair in children with rheumatic heart disease

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.

Received for publication August 25, 2004; revisions received November 1, 2004; accepted for publication November 9, 2004.

^_* Address for reprints: A. Sampath Kumar, MCh, Professor, Department of Cardiothoracic & Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029, India. (E-mail: asampath_kumar{at}hotmail.com).

OBJECTIVE: The purpose of this study was to assess the long-term results of mitral valve repair in children with chronic rheumatic heart disease.

METHODS: From January 1988 through December 2003, 278 children (153 male children) underwent mitral valve repair. Mean age was 11.7 ± 2.9 years (range, 2–15 years). One hundred seventy-three children (62%) were in the New York Heart Association functional class III or IV. Congestive heart failure was present in 24 (8.6%). Reparative procedures included posterior collar annuloplasty (n = 242), commissurotomy (n = 187), cusp-level chordal shortening (n = 94), cusp thinning (n = 71), cleft suture (n = 65), and cusp excision or plication (n = 10). Associated procedures included atrial septal defect closure (n = 22), aortic valve repair/replacement (n = 13), and tricuspid valve repair (n = 3).

RESULTS: Early mortality was 2.2% (6 patients). Preoperative left ventricular dysfunction was associated with greater mortality. Median follow-up was 56.5 months (mean, 58.9. ± 32.3 months; range, 5 to 180 months). One hundred seventy-seven survivors (65%) had no or trivial mitral regurgitation. Sixteen patients (6%) required reoperation for valve dysfunction. There were 7 late deaths (2.6%). Actuarial, reoperation-free, and event-free survivals at a median follow-up of 56.5 months were 95.2% ± 1.5%, 91.6% ± 2.2%, and 55.9% ± 3.5%, respectively; at 15 years, they were 95.2% ± 1.5%, 85.9% ± 5.9%, and 46.7% ± 4.7%, respectively.

CONCLUSION: Mitral valve repair in children with chronic rheumatic heart disease is feasible and provides acceptable long-term results.

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