[Doppler echocardiographic variables and the type of surgery to be performed in rheumatic mitral valve regurgitation].

In our country, rheumatic disease is still one of the most prevalent causes of mitral valve regurgitation. Unlike mitral valve regurgitation caused by myxomatous degeneration or ischemic disease, that caused by rheumatic disease may have restriction and thickening of the leaflets, and marked abnormalities in the subvalvular region 1, which are also commonly associated with valvular stenosis. Rheumatic mitral valve regurgitation usually affects young individuals and should be assessed in a differentiated way in its clinical and surgical approaches. Some studies have reported the superiority of mitral valvuloplasty (conservative surgery) over valvular replacement (prosthesis implantation), when surgical treatment is required. The former has a smaller incidence of infective endocarditis and complications secondary to anticoagulation, and has also been associated with a better preservation of left ventricular systolic function after surgery 2-6. Currently, Doppler echocardiography plays an important role in the early determination of the type of surgery that may be performed for correcting mitral valve regurgitation 7-9. Morphological and functional aspects obtained on Doppler transthoracic and transesophageal echocardiography usually allow estimating at 85% the possibility of performing mitral valvuloplasty and its success in patients with myxomatous degeneration, particularly when the posterior leaflet is the most impaired one 10-12. However, the studies that try to validate Doppler echocardiography as a powerful instrument for predicting the type of surgery to be performed in patients with rheumatic disease lack an expressive number of patients. In fact, the unique characteristics of rheumatic disease decrease the probability of performing mitral valvuloplasty, with rates estimated at 50% 13. So far, the variables obtained on Doppler echocardiography for predicting the surgery to be performed in mitral valve regurgitation of different etiologies are not applicable to patients with the disease of rheumatic etiology. Previous knowledge of the surgery to be performed, determined by the identification of Doppler echocardiographic variables, may help the cardiologist even in deciding the ideal moment for surgical treatment. The subgroups that will benefit most from that information are the patients with severe chronic regurgitation with normal left ventricular function and the following characteristics: a) asymptomatic patients referred for surgery with a high chance of valvuloplasty; b) young patients with a low socioeconomic condition, who have a low adherence to the anticoagulant therapy, if that treatment is mandatory due to metallic prosthetic implantaInstituto Dante Pazzanese de Cardiologia Mailing address: Jorge Eduardo Assef Rua Cravinhos 114/101 Cep 01408-020 São Paulo, SP, Brazil E-mail: [email protected] Received for publication: 06/22/2004 Accepted for publication: 09/03/2004 English version by Stela Maris Costalonga Objective To identify the Doppler echocardiographic variables associated with the type of surgery performed in rheumatic mitral valve regurgitation and to determine the relation between those variables and the medium-term results of valvuloplasty.