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Surgical treatment of acute episodes of rheumatic fever

Published online by Cambridge University Press:  19 August 2008

Pablo Maria Alberto Pomerantzeff ,
Rachel Snitcowsky ,
Isabelle Vianna Trevisan ,
Miguel Barbero Marcial ,
Geraldo Verginelli  and
Adib D Jatene
Pablo Maria Alberto Pomerantzeff*
Affiliation:
Surgical Division of the Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina,Universidade de São Paulo, SãoPaulo
Rachel Snitcowsky
Affiliation:
Surgical Division of the Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina,Universidade de São Paulo, SãoPaulo
Isabelle Vianna Trevisan
Affiliation:
Surgical Division of the Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina,Universidade de São Paulo, SãoPaulo
Miguel Barbero Marcial
Affiliation:
Surgical Division of the Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina,Universidade de São Paulo, SãoPaulo
Geraldo Verginelli
Affiliation:
Surgical Division of the Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina,Universidade de São Paulo, SãoPaulo
Adib D Jatene
Affiliation:
Surgical Division of the Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina,Universidade de São Paulo, SãoPaulo
*
Dr Pablo Maria Alberto Pomerantzeff, Avenida Dr. Encas de Carvalho Aguiat 44, Divisao Ciráuacute;rgica, CEP05403 São Paulo, SP, Brasil. Tel. 11-282-7864, Extension 432; Fax. 11-282-2354.
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Abstract

Eight patients, four males and four females, age five to 13 years old (average: 11 years) have undergone surgery in the acute phase of rheumaticfever. The patients presented a history of rheumatic activity characterized by the presence of migratory arthritis and carditis. All patients had severe acute mitral insufficiency, while one of them had associated aortic insufficiency. Laboratory examinations revealed the presence of an acute inflammatory condition. All patients had acute heart failure and were treated initially with high doses of diuretics, peripheral vasopressor and vasodilator amines, together with cardiotonic drugs, without improvement. Surgical treatment was indicated after a period of observation between 24 hours and five days. In five patients, the Doppler echocardiogram revealed rupture and elongation of tendinous cords. Two of them had acute dilatation of the mitral ring, and one had isolated acute dilatation of the mitral ring. Five patients underwent valvar replacement and, in three, valvar repair was carried out. Two patients, who were in cardiogenic shock at the time of their referral, died in the operating room following replacement of the mitral valve. All patients who underwent repair of the mitral valve were in good condition at the last follow-up, six to 27 months after surgery.

Keywords

Acute rheumatic feversurgical treatmentvalve replacement
Type
World Forum for Pediatric Cardiology Symposium on Rheumatic Fever
Information
Cardiology in the Young , Volume 2 , Issue 3 , July 1992 , pp. 244 - 246
Copyright
Copyright © Cambridge University Press 1992

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