Kalil Ra

Resultado clínico tardio da anuloplastia mitral sem suporte em crianças e adolescentes

Late post-operative clinical results fortreatmentof mitral regurgitation (MR) in patients under 18 years-old by annuloplasty without ring or posterior support are presented. From 1977 to 1995,70 patients: 36 female and 34 male, mean age 12.4 ± 4.8 y (6m to 18y), with pure MR were submitted to an Wooler type of annuloplasty. None received ring or annular support. Twelve (17.1%) had chordal shortening associated. Ethiology was rheumatic 71.4%, congenital 18.6%, myxomatous 8.6% and infectious 1.4%. Preoperative functional class was II: 32 cases (45.7%), III: 18 (25.7%), IV: 20 (28.6%). Twenty-one patients (30%) had associated procedures: on aortic valve 12 (15.2%), tricuspid 4 (5.7%), ASD 4 (5.7%) and aortic and tricuspid 1 (1.4%). Mean perfusion time was 45.2 ± 18.3 min for the whole group and 37.2 ± 11.3 min for annuloplasty alone. Mean ischemic time was 28.4 ± 14.3 min and 21.8 ± 7.1 min respectively. Follow-up time ranged from 7 months to 18 years. Mortality was 4.3% (3 cases) in the early postoperative and 8.6% (6 cases) in the late follow up. Early residual regurgitation was found in 15 patients (21.4%) and 50.0% in 35. Thirteen (18.6%) were reoperated at a mean p.o. time of 56.2 ± 46.2 m. Causes for reoperation: primary MR 5 (38.5%), endocarditis 4 (30.7%), stenosis 2 (15.4%), aortic valve disfunction 1 (7.7%), pulmonary embolism 1 (7.7%). Late evaluation in 46 non-operated survivors: 34 were in functional class I (73.9%), 10 in II (21.7%) and 2 in III (4.3%). Actuarial survival was 93 ± 3% at 5 years and 80 ± 7% at 10 years. Event-free survival was 89 ± 4% and 61 ± 10% at 5 and 10 years. For rheumatic ethiology, event-free survival was 80 ± 8% and 55 ± 16% and, for congenital MR, 90 ± 9% at 5 and 10 years p.o. Simple, unsupported annuloplasty (Wooler type), alone or associated to chordal shortening is an effective and reproducible procedure for MR in children and adolescents. Morbidity and mortality are low in relation to other techniques and prosthetic replacement. Failures were mainly related to rheumatic carditis and infective endocarditis. In growing up patient under 18 years old, this technique would be recommended because it may allow unrestricted development of the mitral orifice.