Resultados da operação reconstrutora da valva mitral em pacientes com idade inferior a 15 anos

Abstract

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

<![CDATA[<B>Reconstrutive surgery of regurgitating mitral valve in children</B>]]>

“…From May 1980 to November 2001, 117 under 15-yearold patients were submitted to conservative surgery of the mitral valve. All patients suffered from mitral valve regurgitation [45].…”

Redução anular intermitente com plastia de Alfieri no tratamento da insuficiência mitral em crianças: resultados iniciais

“…The reduction technique of the annulus in its entire length with small strips of bovine pericardium, intermittently, has two purposes, namely: to maintain the geometry of the annulus with its original characteristics and allow for growth -purposes that would not be achieved if the repair was performed using another approach, because the ring entirely non-biodegradable rigid or flexible maintains appropriate annular geometry, but such type of ring does not allow growth. Segmental rings for repair of the posterior portion of the annulus present good surgical outcomes [24,25], but allow growth only of the anterior portion, which can lead to a situation of geometrical misfit over time. Mitral repair through techniques that use bovine pericardium should provide bridging, in order to allow growth.…”

Doença valvar mitral reumática submetida à plastia com anel de Gregori-Braile

“…At this moment, we have chosen to implant a rigid open ring (Gregori-Braile) considering the patient's age, which poses growth potential and growing requirements. Seven 2-0 polyester threads were initially fixed in the mitral ring and afterwards in the external portion of the prosthesis [1,2]. Perfusion and myocardial ischemia times were 72 minutes and 57 minutes, respectively.…”