The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 994-998, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Mitral valve surgery in children
BR Kalke, JM Desai and R Magotra
Department of Cardiovascular and Thoracic Surgery, T. N. Medical College, Bombay, India.
Between October 1968 and May 1985, 113 symptomatic pediatric patients (15
years or younger) had operation for rheumatic mitral stenosis or
regurgitation. All were in functional classes III and IV of the New York
Heart Association classification. The ages ranged from 5 to 15 years. There
were 59 female and 50 male children. Nine patients also had grade 1 aortic
regurgitation. Seventy-two children with moderately severe to severe mitral
stenosis were treated with closed mitral commissurotomy. One patient with
preoperative embolization had open commissurotomy while receiving
cardiopulmonary bypass. There were two (2.7%) postoperative deaths.
Sixty-one (83.5%) had excellent results, and 10 patients (13.7%) had good
to fair results. Restenosis occurred in 14 patients (23.0%) over a 15-year
period. Of the 40 patients with rheumatic mitral regurgitation, 36 had
valve replacement, and mitral valve reconstruction was carried out in four.
Six of these were in patients with mitral commissurotomy that was carried
out 6, 8, 9, 10, 13, and 15 years earlier. There were four (10.0%) deaths
during the postoperative period and one 8 months after operation resulting
from a choked valve. Twenty-eight patients (80.0%) had excellent results
and seven (20.0%) had fair to good results. Minor episodes of embolization
occurred in three patients. All surviving patients were able to perform
activities of daily living and showed a normal growth pattern. Three to 13
years' follow-up was available in 61 (85.9%) of 71 patients undergoing
mitral commissurotomy who left the hospital and 27 (77.40%) in the mitral
valve replacement/reconstruction group.
