Surgical Treatment of Rheumatic Mitral Valve Lesions in Children and Adolescents

Rheumatismal lesions of the mitral valve a!I'e rare under the age of six and surgical iruter­vention in symptomatic patients is an academic problem. Early surgical treatment has been done to prevent serious changes and unrevers­ib1e complications o.f the heart and lungs.  From April 71 until April 74, thirty-five pati­ent, ranging between 8-18 years of age, suffer­ing of <lifferents heart ,troubles were admitted in the ward of Cardiac Surgery, Pahlavi Hospi­tal University orf Tehran (23 Female and 12 Male).  Twenty of them had only pure M.S. and thlr-teen M.I. In the recent group, some of them had mixture of M.I. + M.S. There was one case of M.S. plus T.I. and another case M.S. + M.I. plus A.S. plus T.S. + T.I. After complete medical treatment surgical operations were performed as follow:  Twenty close mitral commissurotomy and one open mitral commissurotomy in pati-ents with pure M.S.  Fourteen other patients were operated on under cairdiapulmonary by-pass and open heart technic.  In two of them mitral annuloplasty was done for M.I. and in twelve others m1tral valve re­placement with artificial valve was performed. In those cases ,vith A.S. and T.S. + T.I., repadr of the valve without replacement was done.  In the group with mitral valve replacemen,t there were three mortality cases two of them due severe and uncontrolable post operation bleeding and the other one due fo respiratory insufficiency who died eighteen hours after opera,tion.  The result of close mitral commissurotomy is related to several factors s-uch as myocardial lesfous, anatomic situation o.f 1the valve, pre­sence or absence of pulmonary hypertension, lesions ·of the other valves and quality of the operation.  Over-all the results o-f close mitral commis­surotomy are good, although some of them should be reoperated on latter. The results of two annuloplasty were satisfactory. The re­sults of twelve mitral valver replacement ex­cept three mortality cases, were good.