Mitral valve disease in West Indian children results of operative intervention at the University Hospital of the West Indies - abstract

ABSTRACT

Rheumatic carditis and its sequelae tend to run a severe course in West Indian children. The mitral valve is most commonly affected by the disease process, and children thus afflicted often need surgical intervention to provide adequate palliation. A retrospective study of all children under 13 years of age subjected to isolated mitral valve surgery at the University Hospital was undertaken to evaluate the results of the palliative operations performed. There were 15 males and 13 females in the study and their ages ranged from 6 to 12 years (mean 10 yrs.) The operations performed were closed mitral commissurotomy (1), open mitral commissurotomy (1), porcine xenograft mitral valve replacemnet (3), homograft mitral valve replacement 922) and failed porcine homograft (1). Eight patients died of acute cardiac failure within 4 weeks of operation (29 per cent mortality). Of the 20 children surviving operation, 8 died (29 per cent mortality) between 0.25 and 5 years, and the causes of death were congestive cardiac failure (2), following re-operation (3), and infective endocarditis (3). The remaining 12 patients are alive and well and their period of follow-up ranges from 1 to 8.3 years (mean 4.5 years). Clinical and investigative (electrocardiographic and echocardiographic) data indicates a satisfactory functional result following operation. Mitral valve disease complicating rheumatic carditis is frequently encountered at the University Hospital, and the results of surgical intervention have been shown to be satisfactory. Earlier re-operation, when indicated, and stricter criteria for operative intervention, could further improve the results of surgical palliation (AU)