Valvoplastia sem suporte em crianças com anomalias congênitas da valva mitral: resultados clínicos tardios / Unsupported valvuloplasty in children with congenital mitral valve anomalies: late clinical results

OBJECTIVE: To analyze late clinical evolution after surgical treatment of children, with reparative and reconstructive techniques without annular support. METHODS: We evaluated 21 patients operated upon between 1975 and 1998. Age 4.67 + or - 3.44 years; 47.6 percent girls; mitral insufficiency 57.1 percent (12 cases), stenosis 28.6 percent (6 cases), and double lesion 14.3 percent (3 cases). The perfusion 43.10 + or - 9.50min, and ischemia time were 29.40 + or - 10.50min. The average clinical follow-up in mitral insufficiency was 41.52 + or - 53.61 months. In the stenosis group (4 patients) was 46.39 + or - 32.02 months, and in the double lesion group (3 patients), 39.41 + or - 37.5 months. The echocardiographic follow-up was in mitral insufficiency 37.17 + or - 39.51 months, stenosis 42.61 + or - 30.59 months, and in the double lesion 39.41 + or - 37.51 months. RESULTS: Operative mortality was 9.5 percent (2 cases). No late deaths occurred. In the group with mitral insufficiency, 10 (83.3 percent) patients were asymptomatic (p=0.04). The majorit y with mild reflux (p=0.002). In the follow-up of the stenosis group, all were in functional class I (NYHA); and the mean transvalve gradient varied between 8 and 12mmHg, average of 10.7mmHg. In the double lesion group, 1 patient was reoperated at 43 months. No endocarditis or thromboembolism were reported. CONCLUSION: Mitral stenosis repair has worse late results, related to the valve abnormalities and associated lesions. The correction of mitral insufficiency without annular support showed good long-term results

Técnicas reparadoras em crianças com anomalias congênitas da valva mitral: resultados clínicos tardios / Valve repair techniques in children with congenital mitral valve anomalies: late clinical results

Background: Congenital mitral valve disease is associated with complex deformities of mitral apparatus. Annular support should be avoided in children and adolescents. Since 1975 we have employed non-supported techniques for mitral repair. Objective: This paper presents long term clinical results for repair in congenital mitral valve disease in children under 12 years of age. Patients and Methods: This series comprises 21 patients operated from 1995 to 1998. Mean age 4.6 ñ 3.4 years. Female sex 47.6 per cent mitral regurgitation in 57.1 per cent (12 pt), stenosis 28.6 per cent (6 pt) and mixed lesion 14.3 per cent (3 pt). Perfusion time was 43.1 ñ 9.5 min and ischemic time 29.4 ñ 10.5 min. Follow-up time was 41.5 ñ 53.6 months for the regurgitation group (12 pt) and 46.3 ñ 32.0 months for the stenosis group (4 pt followed). Results: Operative mortality was 9.5 per cent (2 cases), both in the stenosis group. There was no late death. In the regurgitation group, 10 pt (83.3 per cent) were assymptomatic. Echocardiographic control at a mean follow-up time of 37.1 ñ 39.5 months showed, in 9 cases, 1 without reflux, 6 mild and 2 moderate reflux. There was 1 reoperation at 48 months post operative for a new valve repair. In the stenosis group, there were 4 patients followed, all in functional class I, 2 without drugs. Echo control at a mean follow-up time of 42.6 ñ 30.5 months showed mean gradient from 8 to 12 mmHg. The mixed lesion group had 1 reoperation after 43 post-operative months. There were no cases of endocarditis or thromboembolism. Conclusion: Mitral valve repair in congenital lesions is associated with good late results. The majority of cases remain assymptomatic and free of reoperations. Failures are related to complexity of deformities. Rings on annular support are not necessary. Repair of regurgitation performs better than these for stenosis.