Repairing the rheumatic mitral valve in the young: The horizon revisited

OBJECTIVE: Most of the rheumatic mitral valve repair literature focuses on older patients with burnt out disease. We present our midterm results of rheumatic mitral valve repair in young patients. METHODS: In this retrospective-prospective study, 106 consecutive children (<18 years) underwent mitral valve repair for rheumatic etiology (2013-2017). Patients were evaluated at regular intervals. RESULTS: The mean age of the cohort was 13.1 ± 3.2 years; 30 (29.6%) patients had recent rheumatic activity (<8 weeks); 80 (78.4%) had mitral regurgitation; 8 (7.8%) had mitral stenosis; 14 (13.7%) had mixed lesions; 11 underwent emergency surgery for intractable heart failure; and 34 (33.3%) patients underwent autologous pericardial augmentation. All patients underwent annuloplasty (ring, band, or other); 40 (39.2%) required chordal procedures. Operative mortality was 1%. Mean follow-up was 25.6 ± 9.5 months and was 100% complete. At last follow-up, mean mitral regurgitation grade was 1.2 ± 0.3, mean mitral valve gradient was 2.96 ± 0.18, and 94.8% of patients were in New York Heart Association class I. Four patients developed recurrent rheumatic carditis (resulting in severe mitral regurgitation), but there were no thromboembolic or hemorrhagic events. Actuarial survival and freedom from reoperation at 2.5 years were 96.2% (number at risk, 38), and 97.1% (number at risk, 38), respectively. CONCLUSIONS: Rheumatic valves in children are eminently repairable. The surgeon who ventures to repair a rheumatic mitral valve should consider all lesions of the various components of the mitral valvular apparatus and must have numerous techniques in the armamentarium to effect a successful repair.