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. 2021 Mar;37(2):175-182.
doi: 10.1007/s12055-020-00925-0. Epub 2020 Mar 25.

Mitral valve repair in children with rheumatic heart disease

Srirup Chatterjee  1 , Nikhil Bansal  1 , Rajarshi Ghosh  1 , Lakshmi Kumari Sankhyan  1 , Sujoy Chatterjee  1 , Santosh Pandey  1 , Satyajit Bose  1
Affiliations

Mitral valve repair in children with rheumatic heart disease

Srirup Chatterjee et al. Indian J Thorac Cardiovasc Surg. 2021 Mar.

Abstract

Purpose: Rheumatic heart disease is the most common acquired heart disease in children in developing countries. The heart valve lesions produce severe hemodynamic changes due to scarring of the valves over time. Around 15.6 million people are affected by rheumatic heart disease (RHD), and 230,000 die around the globe annually. Valve repair should be the primary goal, although it is technically challenging because of the fact that rheumatic process evolves making repair outcomes variable.

Methods: We reviewed the literature for the various techniques done for mitral valve repair in children with rheumatic heart disease. Early and late results of repair were compared with the results found for mitral valve repair done for such children.

Results: Prosthetic heart valve implantation in children has major negative impact on their immediate- and long-term survival as well as on quality of their life. Valve repair is associated with improved ventricular function because the normal valve tissue and subvalvular apparatus are preserved, reduced complications related to prosthetic valve, and lower in-hospital and late mortality.

Conclusion: In children, the results of mitral valve replacement were found to be inferior to those of mitral valve repair. The reoperation rates are similar in patients undergoing initial repair or replacement, which favors repair as an option. In developing world, rheumatic mitral valve disease is more prevalent where adequate facilities for monitoring of prosthetic valve function and management of anticoagulation therapy are not easily available. Valve repair therefore should be the primary goal.

Keywords: Annuloplasty; Artificial chordae; Mitral valve repair; Pericardial patch augmentation; Rheumatic heart disease.

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Conflict of interest statement

Conflict of interestThe authors declare that they have no conflict of interest.

Figures

Fig. 1
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Measuring the anterior leaflet
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Annuloplasty ring
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Chordal transfer
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Commisurotomy
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Pericardial patch augmentation
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Chordal shortening
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Thickened papillary muscle
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Leaflet peeling/shaving
See this image and copyright information in PMC

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