Reconstructive surgery of the mitral valve, post-rheumatic fever, in children

LETTER TO THE EDITOR

Reconstructive surgery of the mitral valve, post-rheumatic fever, in children

Rui M. S. Almeida

Universidade Estadual do Oeste do Paraná, Faculdade Assis Gurgacz, Instituto de Cirurgia Cardiovascular do Oeste do Paraná, Cascavel, PR - Brazil

Mailing address

Key words: Mitral valve/surgery; rheumatic fever; child.

We would like to congratulate Silva et al¹ on the excellent results about the surgical reconstruction of the mitral valve (MV) in children, post-rheumatic fever (RV). In our country, this matter is of utmost importance due to its high incidence and also for the assessment of their results at this age range. After a careful reading of the aforementioned study, some doubts arose regarding the percentage of valve plasties and changes, for the same period and the same age range. Although 80% of the patients were in NYHA functional class III or IV, the severity of the anatomic lesion of the MV is unknown, a fact that has been established as worsening the final result, as well as the choice of the surgical technique². Chauvaud et al³ demonstrated that reconstructive surgery for valvular lesions, at this age range, can be performed in up to 92% of the cases, with good short and longterm results. A pioneer study of 72 patients in MV reconstructive surgery post-RF carried out in our country⁴, at this age range, demonstrated the possibility of performing the mitral valve plasty in only two-thirds of the patients, due to the complexity of the anatomic lesion.

When the two groups are compared, it can be observed that the demographic data of the two series are similar, including the incidence of reoperations. However, the authors did not specify whether these were performed due to problems with the technique or due to new onsets of rheumatic activity. In our experience⁴, in 9 of the 13 (69.2%) of the patients submitted to reoperation, the cause was a new onset of RF due to socioeconomic and social assistance problems that led to the lack of adequate prophylaxis.

Once again, we congratulate the authors for the results presented in the abovementioned study.

References

• 1. Silva AR, Herdy GVH, Vieira AA, Simões LC. Plastia mitral cirúrgica em crianças com febre reumática. Arq Bras Cardiol. 2009; 92 (6): 433-8.
• 2. Volpe MA, Braile DM, Vieira RW, Souza DR. Mitral valve repair with a malleable bovine pericardium ring. Arq Bras Cardiol. 2000; 75 (5): 389-96.
• 3. Chauvaud S, Perier P, Touati G, Relland J, Kara SM, Benomar M, Carpentier A. Long-term results of valve repair in children with acquired mitral valve incompetence. Circulation. 1986; 74 (3 Pt 2): I104-9.
• 4. Almeida RS, Ribeiro EJ, Bassi SL, Brofman PR, Loures DR. Reconstructive surgery for rheumatic mitral valvar disease in children: perspectives in pediatric cardiology. In: Crupi G, Parenzan L, Anderson RH. (eds.). New York: Futura Publishing Company Inc; 1990. p. 141-4.

Publication Dates

• Publication in this collection
  22 Sept 2010
• Date of issue
  Apr 2010