Mitral valve surgery in children.

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.

A new surgical approach to the management of symptomatic aberrant right subclavian artery.

Aberrant right subclavian artery is a rare congenital anomaly that usually does not produce symptoms. Symptomatic patients require surgical intervention. Ligation of the aberrant artery through a left thoracotomy has been advocated as the operation of choice. If development of vertebrobasilar insufficiency is anticipated, division and ligation of the aberrant artery and its anastomosis to the right common carotid artery or aortic arch are performed at a second operation. In the procedure advocated here, both ligation and anastomosis of the aberrant artery are performed simultaneously through midsternotomy. Normal blood flow is thereby established to the right upper extremity, which obviates any early or late complications.