Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-28T01:10:26.087Z Has data issue: false hasContentIssue false
  • English
  • Français

Surgery for rheumatic lesions of the cardiac valves in the young

Published online by Cambridge University Press:  19 August 2008

Fernando A. Lucchese ,
João Ricardo M. Sant'Anna ,
Renato A. K. Kalil ,
Rogério E. Sarmento Leite ,
Paulo R. Prates  and
Ivo A. Nesralla
Fernando A. Lucchese*
Affiliation:
Department of Surgery, Institute of Cardiology, Porto Alegre
João Ricardo M. Sant'Anna
Affiliation:
Department of Surgery, Institute of Cardiology, Porto Alegre
Renato A. K. Kalil
Affiliation:
Department of Surgery, Institute of Cardiology, Porto Alegre
Rogério E. Sarmento Leite
Affiliation:
Department of Surgery, Institute of Cardiology, Porto Alegre
Paulo R. Prates
Affiliation:
Department of Surgery, Institute of Cardiology, Porto Alegre
Ivo A. Nesralla
Affiliation:
Department of Surgery, Institute of Cardiology, Porto Alegre
*
Dr Fernando A. Lucchese, Department of Surgery,Institute of Cardiology, Avenida Princesa Isabel 395, Porto Alegre 90620, Brazil RS.
Get access Rights & Permissions [Opens in a new window]

Summary

Although declining in the so-called “first world,” surgery for rheumatic valvar lesions in patients less than 16 years of age is still a challenging problem in lesser developed countries. From 1970 to 1990, we operated upon and followed-up 136 children (less than 16 years) with different valvar lesions, performing various surgical procedures. The mitral valve was most frequently affected (52.9%) followed by multiple valvar disease (39.7%) and aortic (7.3%) involvement. The operations performed were valvoplasties (67), valvar replacement (49), and combined procedures (20). Hospital mortality for the overall group was 10.2%. There were 71 reinterventions in the follow-up of 20 years. Actuarial survival was 60.3% including hospital mortality. The event-free actuarial survival showed that 91% had at least one major event which required reoperation or hospital treatment, or else invasive cardiac procedures. We conclude that rheumatic valvar disease is still a challenging problem in our country, and that the severity of the illness is directly related to the younger age patients. In spite of reasonable long-term survival, very few patients had an uneventful follow-up after surgery.

Type
World Forum for Pediatric Cardiology Symposium on Rheumatic Fever
Information
Cardiology in the Young , Volume 2 , Issue 3 , July 1992 , pp. 247 - 253
Copyright
Copyright © Cambridge University Press 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Lucchese, FA, Sant'Anna, JRM. Febre Reumática: Tratamiento quirúrgico en la edad pediátrica. In: Sánchez, P. (ed). Cardiologia Pediatrica-Clinicay Cirugía. Salvat Editores, Tomo II, 1986, pp 907–911.Google Scholar
2. Di Sciascio, G, Taranta, A. Rheumatic fever in children. Am Heart J 1980; 99: 635–642.CrossRefGoogle ScholarPubMed
3. John, S, Krishnaswami, S, Jairaj, PS, Cherian, G, Muralidharan, S, Sukumar, IP. The profile and surgical management of mitral stenosis in young patients. J Thorac Cardiovasc Surg 1975; 69: 631–638.CrossRefGoogle ScholarPubMed
4. Antunes, MJ, Magalhaes, MP, Colsen, PR, Kinsley, RH. Valvuloplasty for rheumatic mitral valve disease. J Thorac Cardiovasc Surg 1987; 94: 44–56.CrossRefGoogle ScholarPubMed
5. Abid, F, Mzah, N, Euch, EE, Ismail, MB. Valve replacement in children under 15 years with rheumatic heart disease. Pediatr Cardiol 1989; 10: 199–204.CrossRefGoogle ScholarPubMed
6. John, S, Bashi, VV, Jairaj, PS, Muralidharan, S, Ravikumar, E, Rajarajeswari, T, Krishnaswami, S, Sukumar, IP, Sundar Rao, PSS. Closed mitral valvotomy: early results and long-term follow-up of 3724 consecutive patients. Circulation 1983; 68: 891–896.CrossRefGoogle ScholarPubMed
7. John, S, Ravikumar, E, Jairaj, PS, Chowdhury, U, Krishnaswami, S. Valve replacement in the young patient with rheumatic heart disease. J Thorac Cardiovasc Surg 1990; 99: 631–638.CrossRefGoogle Scholar
8. Williams, WG, Pollock, JC, Geiss, DM, Trusler, GA, Fowler, RS. Experience with aortic and mitral valve replacement in children. J Thorac Cardiovasc Surg 1981; 81: 326–333.CrossRefGoogle ScholarPubMed
9. Curcio, CA, Commerford, MB, Rose, AG, Stevens, JE, Barnard, MS. Calcification of glutaraldehyde-preserved porcine Xenografts in young patients. J Thorac Cardiovasc Surg 1981; 81: 621–625.CrossRefGoogle ScholarPubMed
10. Berry, BE, Ritter, DG, Wallace, RB, McGoon, DC, Danielson, GK. Cardiac valve replacement in children. J Thorac Cardiovasc Surg 1974; 68: 705–710.CrossRefGoogle ScholarPubMed
11. Robbins, RC, Bowman, FO Jr, Malm, JR. Cardiac valve replacement in children: A twenty-year series. Ann Thorac Surg 1988; 45: 56–61.CrossRefGoogle ScholarPubMed
12. Chauvaud, S, Perier, P, Touati, G, Relland, J, Kara, SM, Benomar, M, Carpentier, A. Long-term results of valve repairin children with acquired mitral valve incompetence. Circulation 1986; 74 (SuppI I): I104–I109.Google Scholar
13. Kalil, RAK, Lucchese, FA, Prates, PR, Sant'Anna, JRM, Pereira, EC, Nesralla, IA. Unsupported annuloplasty for rheumaticmitral regurgitation. Presented at The American College of Cardiology 41st Annual Scientific Session, Dallas, Texas, April, 1992.Google Scholar
14. Edmunds, LH Jr. Thrombotic and bleeding complications of prosthetic heart valves. Ann Thorac Surg 1987; 44: 430–445.CrossRefGoogle ScholarPubMed
15. Bradley, LM, Midgley, FM, Watson, DC, Getson, PR, Scott, LP III. Anticoagulation therapy in children with mechanical prosthetic cardiac valves. Am J Cardiol 1985; 56: 533–535.CrossRefGoogle ScholarPubMed
16. Kutsche, LM, Oyer, P, Shumway, N, Baum, D. An important complication of Hancock mitral valve replacement in children. Circulation 1979; 60(Suppl I): I 98–I 103.CrossRefGoogle ScholarPubMed
17. Sanders, SP, Levy, RJ, Freed, MD, Norwood, WI, Castañeda, AR. Use of Hancock porcine xenografts in children and adolescents. Am J Cardiol 1980; 46: 429–438.CrossRefGoogle ScholarPubMed
18. Braunwald, NS, Brais, M, Castañeda, AR. Considerations in the development of artificial heart valve substitutes for use in infants and small children. J Thorac Cardiovasc Surg 1976; 72: 539–546.CrossRefGoogle Scholar
19. Friedman, S, Edmunds, LH Jr, Cuaso, CC. Long-term mitral valve replacement in young children. Circulation 1978; 57: 981–986.CrossRefGoogle ScholarPubMed
20. Lillehei, CW, Levy, MJ, Bonnabeau, RC Jr. Mitral valve replacement with preservation of papillary muscles and chordaetendineae. J Thorac Cardiovasc Surg 1964; 47: 532–543.CrossRefGoogle Scholar
21. David, TE, Burns, RJ, Bacchus, CM, Druck, MN. Mitral valve replacement for mitral regurgitation with and without preservation of chordae tendineae. J Thorac Cardiovasc Surg 1984; 88: 718–725.CrossRefGoogle ScholarPubMed
22. David, TE, Uden, DE, Strauss, HD. The importance of the mitral apparatus in left ventricular function after correction of mitral regurgitation. Circulation 1983; 68(Suppl II): II 76–II 82.Google ScholarPubMed
23. Attie, F, Kuri, J, Zanoniani, C, Renteria, V, Buendia, A, Ovseyevitz, J, Lopez-Soriano, F, Garcia-Cornejo, M, Martinez-Rios, MA. Mitral valve replacement in children with rheumatic heart disease. Circulation 1981; 64: 812–817.CrossRefGoogle ScholarPubMed
24. King, RM, Schaf, FHV, Danielson, GK, Gersh, BJ, Orszulak, TA, Piehler, JM, Puga, FJ,Pluth, JR. Surgery for tricuspid regurgitation late after mitral valve replacement. Circulation 1984; 70(Suppl I):I 193–I 197.Google ScholarPubMed
25. Baughman, KL, Kallmann, CH, Yurchak, PM, Daggett, WM, Buckley, MJ. Predictors of survival after tricuspid valve surgery. Am J Cardiol 1984; 54: 137–141.CrossRefGoogle ScholarPubMed
26. Breyer, RH, McClenathan, JH, Michaelis, LL, Mcintosh, CL, Morrow, AG. A comparison of nonoperative management, tricuspid annuloplasty, and tricuspid valve replacement. J Thorac Cardiovasc Surg 1976; 72: 867–874.CrossRefGoogle ScholarPubMed
27. Attie, F, Lopez-Soriano, F, Ovseyevitz, J, Martinez, J, GilMoreno, M, Buendia, A, Chavez-Dominguez, R, Richheirner, R. Late results of mitral valve replacement with the Bjork Shiley prosthesis in children under 16 years of age. J Thorac Cardiovasc Surg 1986; 91: 754–758.CrossRefGoogle ScholarPubMed
28. John, S, Bashi, VV, Jairaj, PS, Muralidharan, S, Ravikumar, E, Sathyamoorthy, I, Babuthaman, C, Krishnaswamy, S, Cherian, G, Sukumar, IP. Mitral valve replacement in the young patient with rheumatic heart disease. J Thorac Cardiovasc Surg 1983; 86: 209–216.CrossRefGoogle Scholar
29. McGoon, MD, Fuster, V, McGoon, DC, Pumphrey, CW, Pluth, JR, Elveback, LR. Aortic and mitral valve incompetence: long term follow-up (10 to 19 years) of patients treated with the Starr-Edwards Prosthesis. J Am Coll Cardiol 1984; 3: 930–938.CrossRefGoogle Scholar