Avaliação cardiológica tardia de crianças com insuficiência mitral reumática, submetidas a cirurgia reconstrutora com anel de Gregori

Abstract

OBJECTIVEAssess late cardiological evolution of children with rheumatic mitral regurgitation (RMR) who underwent mitral valve reconstructive surgery with implantation of Gregori's ring (MVR), from 1987 to 2003. METHODSA study was conducted to analyze a series of cases of 43 children with RMR who underwent MVR with ages ranged from fi ve to twelve years (mean age 9.7 ± 2.2 years); 25 of the patients were females (58.1%). Patients were evaluated as per the following clinical parameters: functional class of heart failure, heart auscultation, electrocardiogram, chest X-ray and echocardiographic fi ndings. RESULTSForty-three patients underwent preoperative evaluation during the postoperative period, the number of patients evaluated decreased to 31 due to the fact that six patients had died and six others underwent valve replacement surgery. Follow-up was carried out for one hundred percent of the patients. A signifi cant reduction of heart failure functional class was observed. Mitral systolic murmur became lesss intense during the postoperative period. The cardiac area on chest X-ray and the presence of left ventricular overload on electrocardiogram were reduced, as well as the mitral regurgitation level on echocardiographic study. After 188 months, the survival rate was 82%, and the annual mortality rate, 0.38%. Thirty-one (72.6%) patients did not require reoperation and the annual rate of patients who required further surgery was 0.51%. CONCLUSIONMVR is an effective procedure for treating RMR in children, resulting in a signifi cant improvement of functional class, mitral systolic murmur and level of mitral regurgitation, as shown on Doppler echocardiogram. KEY WORDSr h e u m a t i c m i t r a l r e g u r g i t a t i o n, c h i l d r e n, annuloplasty

Plastia mitral cirúrgica em crianças com febre reumática

“…In the present study, transesophageal echocardiography was used in most of the patients (68.3%) during the surgical procedure. Also, we observed improved regurgitation in 94.6%, a result similar to that of other Brazilian studies 16,18 .…”

“…The three patients who died were in functional class IV, and two of them were in the acute phase of the disease. This mortality rate may be considered high if compared with those of most of the authors, which range from 0 to 4.8% [17][18][19][20] . Carpentier reported his 10-year experience with repair, with an in-hospital mortality of 4.2% in adults and children 14 .…”

“…Gillinov et al reported reoperation-free survival in 93% after 10 years 22 ; the reason for the need of a new surgery was new bouts of rheumatic fever in most of the patients. In Machado et al 18 case series, 72.6% of the cases were free from reoperation after 188 months. The major causes of failure in rheumatic mitral repair are wrong indications, use of inadequate techniques, and progression of the rheumatic valve disease 7,16 .…”

“…Patients with rheumatic valve disease have had a high incidence of reoperation, as demonstrated by Deloche et al 9 . Reoperation rates range from 8% to 10% 7,18 . Additionally, the outcomes also depend on the status of the valve at the moment of reconstruction, that is, the more severely it is damaged, the worse the outcome 16 .…”