Surgical management of heart valve disease in children

ABSTRACT

From 1-1.1984 to 31.12.1988, 1022 patients had heart valve operations at our institute 17% [170] out of these were 15 years or Younger in age. 59 patients had mitral stenosis [MS], 50 had mitral regurgitation [MR], 22 had both mitral stenosis and regurgitation [MS, MR], 22 had mitral and aortjc regurgitation [MR, AR] and 17 had aortic valve Stenosis or regurgitation [AS or AR]. 47 patients had closed mitral valvotomy [CMV], 35 and 15 and 19 had mitral, aortic and double valve replacement [MVR, AVE, DVR] respectively 42 patients Underwent mitral valve repair [MV repair] procedure Open Mitral Valvotomy [OMV], double valve repair [DV Repair]. Aortic valve repair and aortic valvotomy was carried out in another 12 patients Overall operative mortality [30 days] was 6.4% Assessment of disability after 3 months showed 80% of the patients were either asymptomatic or in NYHA class I and II. 65% of the patients had a valve Conserving operations [Group A] and 35% had the valve replaced [Group B]. After an average follow up of 39 months, Group A patients [n 111] had 3 operative deaths, no minor or major embolic episodes, no endocarditis, no permanent anticoagulants no bleeding and 3 re-Operations 10 had mild to moderate residual regurgitation 7 were lost to follow up and 1 late mortality. Group B patients [n 57] had 8 operative deaths, 4 minor and one major embolic episodic, 2 endocarditis 49 had permanent anticoagulants with 5 patients having bleeding, 2 peraprosthetic leaks, 3 late deaths and only 3 were lost to follow up. We Conclude that 17% of Our valve patients are 15 years or Younger in age. The best valve conserving operation in appropriate patients in CMV. Majority of the valves, Particularly mitrals, can be preserved by either CMV or open repairative procedures. Both early and late mortality morbidity and economics are very favorable in those who have their valves conserved at surgery it is strongly felt that in Developing Countries learning Practicing and improving valve Conserving techniques for young patients should be a major consideration for cardiac surgeons