From October 1987 to March 1993, 105 patients were studied who have undergone valvuloplasty with an open ring. They ranged from 5 to 79 years (mean 30); 33 (31.4%) were under 16. All patients had mitral insufficiency, alone in 62 (59.0%) and associated with mitral stenosis (double mitral lesion) in 43 (41.0%). In the majority of the cases, the aetiology was rheumatic (78.1%); active in 10 (9.5%) patients. Three patients (2.9%) were in class II, 42 (40.0%) in class III, 57 (54.3%) in class IV and 3 (2.9%) in class V. Ten patients (9.5%) had isolated ring implantation while the remaining underwent associated procedures on the leaflets, chordae and papillary muscles. There were two (1.9%) hospital deaths, and six patients (5.7%) had to be reoperated. On the 30th (mean) postoperative day, 75 (71.4%) patients were reevaluated by catheterization, echo Doppler or both to confirm the effectiveness of the techniques employed. The mitral valve was functioning normally or with mitral regurgitation + in 63 (84.0%) patients, mitral regurgitation + + in 2 (2.7%), mitral regurgitation + + + in 5 (6.7%), mitral stenosis + in 4 (5.3%), and mitral stenosis + + in 1 (1.3%) patient. The results were therefore considered excellent in 63 (84.0%) patients with either normal mitral valve or mitral regurgitation +, good in 6 (8.0%) patients with mitral regurgitation + + and/or mitral stenosis +, and poor in 6 (8.0%) patients with mitral regurgitation + + + and/or mitral stenosis + +. Two deaths (1.9%) occurred within the first 7 months of follow-up. Patients were evaluated clinically 1-67 months postoperatively (mean 27):90 (85.7%) were in class I, 4 (3.8%) in class II, 4 (3.8%) in class III and 1 (1.0%) in class IV.(ABSTRACT TRUNCATED AT 250 WORDS)

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Objective: To evaluate the evolution of under 15-year-old patients suffering from mitral valve reflux submitted to mitral valve repair surgery. Method: A total of 117 under 15-year-old patients, submitted to mitral valvuloplasty from May 1980 to November 2001 were evaluated. Their ages ranged from 1 to 15 years old, with a mean age of 10 years. Seventy-four patients (63.2%) were female. The most common etiology was rheumatic disease (81.2%). Eighty-seven patients (74.4%) presented with mitral valve reflux and 30 (25.6%) also suffered from stenosis. Other diseases were associated in 28 patients (23.9%) with aortic valve disease being the most common (13.7%). Several techniques were employed for valve repair such as the shortening or lengthening of the chordae tendineae and papillectomy. Results: Late evolution demonstrated that 96.6% of the patients survived and 88.9% retained their native valves. Fifteen patients (12.8%) underwent reoperations. The mitral valve was remodeled in all patients, with Gregori-Braile rings used in 69 (58.9%) and Carpentier rings in 35 (29.9%). The most commonly used techniques were shortening of the chordae tendineae in 66 patients (56.4%), and commissurotomy and/or papillectomy in 30 patients (25.6%). There was 1 hospital death (0.9%) and 3 late deaths (2.6%). Conclusions: Reconstruction surgery to treat reflux of the mitral valve is possible, presenting results that support its use in under 15-year-old patients. Descriptors: Mitral valve, children. Mitral reflux, repair techniques. Resumo Objetivo: Avaliar a evolução dos pacientes portadores de regurgitação valvar mitral menores de 15 anos submetidos à operação reconstrutora da valva mitral. Método: Cento e dezessete pacientes com idade inferior a 15 anos, submetidos à plastia valvar mitral, no período de maio de 1980 a novembro de 2001. A idade variou de 1 a 15 anos, com média de 10 anos. Setenta e quatro pacientes (63,2%) eram do sexo feminino. A etiologia mais freqüente foi a doença reumática (81,2%). Oitenta e sete pacientes (63,2%) apresentavam regurgitação mitral e 30 (25,6%) Resultados da operação reconstrutora da valva mitral em pacientes com idade inferior a 15 anos Outcomes of mitral valve repair surgery in under 15-year-old patients 116 CORDEIRO, CO ET AL-Outcomes of mitral valve repair surgery in under 15-year-old patients

commissural lines could hardly move the heavy cusps. In the case of bicuspid orifices, the common feature was that jet areas were imaged along the abnormal single commissural line regardless of the lesion, delineating the anatomic slit by their abnormal axis of flow, whether or not they had an eccentric onset. The latter could be explained by a frequent prolapse of a part of the conjoined cusp. Onsets at other sites along the slit remain possible, necessitating further studies.Two further points should also be discussed. First, there are limitations of Doppler imaging. Indeed, at this early technologic stage, present imaging technology is still rough and improvements are required. Second, comparisons between surgical visualization of controlled arrested hearts and Doppler imaging of live ones were limited in this study to sites of areas versus number of cusps. More refined correlations requiring a close cooperation between users of Doppler echocardiography and surgeons should help to extend the indications for surgical repair procedures in the future.

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