Mitral valve repair in children with rheumatic heart disease

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

References

  1. 1.

    Mendis S, Puska P, Norrving B, World Health Organization. Global atlas on cardiovascular disease prevention and control. Geneva: World Health Organization; 2011.

  2. 2.

    Yakub MA, Dillon J, Krishna Moorthy PS, Pau KK, Nordin MN. Is rheumatic aetiology a predictor of poor outcome in the current era of mitral valve repair? Contemporary long-term results of mitral valve repair in rheumatic heart disease. Eur J Cardiothorac Surg. 2013;44:673–81.

    Article  Google Scholar 

  3. 3.

    Dillon J, Yakub MA, Kong PK, Ramli MF, Jaffar N, Gaffar IF. Comparative long-term results of mitral valve repair in adults with chronic rheumatic disease and degenerative disease: is repair for “burnt-out” rheumatic disease still inferior to repair for degenerative disease in the current era? J Thorac Cardiovasc Surg. 2015;149:771–9.

    Article  Google Scholar 

  4. 4.

    David TE, Burns RJ, Bacchus CM, Druck MN. Mitral valve replacement for mitral regurgitation with and without preservation of chordae tendineae. J Thorac Cardiovasc Surg. 1984;88:718–25.

    CAS  Article  Google Scholar 

  5. 5.

    Goldman ME, Mora F, Guarino T, Fuster V, Mindich BP. Mitral valvuloplasty is superior to valve replacement for preservation of left ventricular function: an intraoperative two-dimensional echocardiography study. J Am Coll Cardiol. 1987;10:568–75.

    CAS  Article  Google Scholar 

  6. 6.

    Carpentier A, Chauvaud S, Fabiani JN, et al. Reconstructive surgery of mitral valve incompetence: ten-year appraisal. J Thorac Cardiovasc Surg. 1980;79:338–48.

  7. 7.

    Perier P, Deloche A, Chauvaud S, et al. Comparative evaluation of mitral valve repair and replacement with Starr, Björk, and porcine valve prostheses. Circulation. 1984;70:I187–92.

  8. 8.

    Wang YC, Tsai FC, Chu JJ, Lin PJ. Midterm outcomes of rheumatic mitral repair versus replacement. Int Heart J. 2008;49:565–76.

    Article  Google Scholar 

  9. 9.

    Carpentier A. Cardiac valve surgery-the “French correction”. J Thorac Cardiovasc Surg. 1983;86:323–37.

    CAS  Article  Google Scholar 

  10. 10.

    Kalangos A. The rheumatic mitral valve and repair techniques in children. In: Seminars in Thoracic and Cardiovascular Surgery, vol. 15: Pediatr Card Surg Annu; 2012. p. 80–7.

  11. 11.

    Kalangos A, Beghetti M, Vala D, et al. Anterior mitral leaflet prolapse as a primary cause of pure rheumatic mitral insufficiency. Ann Thorac Surg. 2000;69:755–61.

  12. 12.

    Kalangos A, Sierra J, Vala D, et al. Annuloplasty for valve repair with a new biodegradable ring: an experimental study. J Heart Valve Dis. 2006;15:783–90.

  13. 13.

    Khamooshian A, Buijsrogge MP, De Heer F, Gründeman PF. Mitral valve annuloplasty rings: review of literature and comparison of functional outcome and ventricular dimensions. Innovations. 2014;9:399–415.

    PubMed  Google Scholar 

  14. 14.

    Bortolotti U, Milano AD, Frater RW. Mitral valve repair with artificial chordae: a review of its history, technical details, long-term results, and pathology. Ann Thorac Surg. 2012;93:684–91.

    Article  Google Scholar 

  15. 15.

    Komeda M, Bolger AF, DeAnda JA, Tomizawa Y, Ingels JN, Miller DC. Improving methods of chordal sparing mitral valve replacement. Part I: a new, non-distorting isovolumic balloon preparation for the left ventricle with intact mitral subvalvular apparatus. J Heart Valve Dis. 1996;5:376–82.

    CAS  PubMed  Google Scholar 

  16. 16.

    Zussa C, Polesel E, Rocco F, Galloni M, Frater RW, Valfré C. Surgical technique for artificial mitral chordae implantation. J Card Surg. 1991;6:432–8.

    CAS  Article  Google Scholar 

  17. 17.

    Calafiore AM. Choice of artificial chordae length according to echocardiographic criteria. Ann Thorac Surg. 2006;81:375–7.

    Article  Google Scholar 

  18. 18.

    Doi A, Iida H, Sunazawa T. Intracardiac calipers for artificial chordae replacement in mitral valve repair. Ann Thorac Surg. 2009;87:326–8.

    Article  Google Scholar 

  19. 19.

    Izumoto H, Kiyoyuki E, Ohuchi S, Kawazoe K. New technique of posterior mitral annuloplasty. J Card Surg. 1999;14:270–2.

    CAS  Article  Google Scholar 

  20. 20.

    Chauvaud S, Jebara V, Chachques JC, et al. Valve extension with glutaraldehyde-preserved autologous pericardium. Results in mitral valve repair. J Thorac Cardiovasc Surg. 1991;102:171–7.

  21. 21.

    Duran CM, Gometza B, De EV. Valve repair in rheumatic mitral disease. Circulation. 1991;84:125–32.

    Google Scholar 

  22. 22.

    Zegdi R, Ould-Isselmou K, Fabiani JN, Deloche A. Pericardial patch anterior leaflet extension in rheumatic mitral insufficiency. Eur J Cardiothorac Surg. 2011;39:1061–3.

    Article  Google Scholar 

  23. 23.

    Gupta A, Gharde P, Kumar AS. Anterior mitral leaflet length: predictor for mitral valve repair in a rheumatic population. Ann Thorac Surg. 2010;90:1930–3.

    Article  Google Scholar 

  24. 24.

    Fu JT, Popal MS, Jiao YQ, et al. A predictor for mitral valve repair in patient with rheumatic heart disease: the bending angle of anterior mitral leaflet. J Thorac Dis. 2018;10:2908–15.

  25. 25.

    Talwar S, Rajesh MR, Subramanian A, Saxena A, Kumar AS. Mitral valve repair in children with rheumatic heart disease. J Thorac Cardiovasc Surg. 2005;129:875–9.

    Article  Google Scholar 

  26. 26.

    Bernal JM, Pontón A, Diaz B, et al. Combined mitral and tricuspid valve repair in rheumatic valve disease: fewer reoperations with prosthetic ring annuloplasty. Circulation. 2010;121:1934–40.

  27. 27.

    Schaff HV. Mitral valve repair in patients with rheumatic heart disease: what are the limits? J Thorac Cardiovasc Surg. 2015;149:779–80.

    Article  Google Scholar 

  28. 28.

    Duran CM, Gometza B, Balasundaram S, al Halees Z. A feasibility study of valve repair in rheumatic mitral regurgitation. Eur Heart J. 1991;12:34–8.

  29. 29.

    Skoularigis J, Sinovich V, Joubert G, Sareli P. Evaluation of the long-term results of mitral valve repair in 254 young patients with rheumatic mitral regurgitation. Circulation. 1994;90:167–74.

    Google Scholar 

  30. 30.

    Chauvaud S, Fuzellier JF, Berrebi A, Deloche A, Fabiani JN, Carpentier A. Long-term (29 years) results of reconstructive surgery in rheumatic mitral valve insufficiency. Circulation. 2001;104:112–5.

  31. 31.

    Brown JW, Fiore AC, Ruzmetov M, Eltayeb O, Rodefeld MD, Turrentine MW. Evolution of mitral valve replacement in children: a 40-year experience. Ann Thorac Surg. 2012;93:626–33.

    Article  Google Scholar 

  32. 32.

    Xu M, McHaffie DJ, Hilless AD. Mitral valve repair: a clinical and echocardiographic study. Heart. 1994;71:51–6.

    CAS  Article  Google Scholar 

  33. 33.

    Dillon J, Yakub MA, Nordin MN, Pau KK, Krishna Moorthy PS. Leaflet extension in rheumatic mitral valve reconstruction. Eur J Cardiothorac Surg. 2013;44:682–9.

    Article  Google Scholar 

  34. 34.

    Antunes MJ, Kinsley RH. Mitral valve annuloplasty: results in an underdeveloped population. Thorax. 1983;38:730–6.

    CAS  Article  Google Scholar 

  35. 35.

    Antunes MJ. Mitral valvuloplasty, a better alternative. Comparative study between valve reconstruction and replacement for rheumatic mitral valve disease. Eur J Cardiothorac Surg. 1990;4:257–62.

  36. 36.

    Antunes MJ. Repair for rheumatic mitral valve disease. The controversy goes on! Heart. 2018;104:796–7.

    Article  Google Scholar 

  37. 37.

    Gometza B, Al-Halees Z, Shahid M, Hatle LK, Duran CM. Surgery for rheumatic mitral regurgitation in patients below twenty years of age. An analysis of failures. J Heart Valve Dis. 1996;5:294–301.

    CAS  PubMed  Google Scholar 

  38. 38.

    John S, Ravikumar E, Jairaj PS, Chowdhury UJ, Krishnaswami S. Valve replacement in the young patient with rheumatic heart disease. Review of a twenty-year experience. J Thorac Cardiovasc Surg. 1990;99:631–8.

    CAS  Article  Google Scholar 

  39. 39.

    Antunes MJ, Vanderdonck KM, Sussman MJ. Mechanical valve replacement in children and teenagers. Eur J Cardiothorac Surg. 1989;3:222–8.

    CAS  Article  Google Scholar 

  40. 40.

    Pomerantzeff PM, Brandao CM, Faber CM, et al. Mitral valve repair in rheumatic patients. Heart Surg Forum. 2000;3:273–6.

  41. 41.

    Kalangos A, Christenson JT, Beghetti M, Cikirikcioglu M, Kamentsidis D, Aggoun Y. Mitral valve repair for rheumatic valve disease in children: midterm results and impact of the use of a biodegradable mitral ring. Ann Thorac Surg. 2008;86:161–9.

    Article  Google Scholar 

  42. 42.

    Salem A. Abdelgawad, Elshemy A. early and midterm outcomes of rheumatic mitral valve repair. Heart Surg Forum. 2018;21:E352–8.

    Article  Google Scholar 

  43. 43.

    Fu JT, Popal MS, Zhang HB, et al. A meta-analysis of late outcomes of mitral valve repair in patients with rheumatic heart disease. J Thorac Dis. 2017;9:4366–4375.

  44. 44.

    McGurty D, Remenyi B, Cheung M, et al. Outcomes after rheumatic mitral valve repair in children. Ann Thorac Surg. 2019;108:792–7.

  45. 45.

    Krishna Moorthy PS, Sivalingam S, Dillon J, Kong PK, Yakub MA. Is it worth repairing rheumatic mitral valve disease in children? Long-term outcomes of an aggressive approach to rheumatic mitral valve repair compared to replacement in young patients. Interact Cardiovasc Thorac Surg. 2019;28:191–8.

    Article  Google Scholar 

  46. 46.

    Erez E, Kanter KR, Isom E, Williams WH, Tam VK. Mitral valve replacement in children. J Heart Valve Dis. 2003;12:25–9.

    PubMed  Google Scholar 

  47. 47.

    Ziperovich S, Paley HW. Severe mechanical hemolytic anemia due to valvular heart disease without prosthesis. Ann Intern Med. 1966;65:342–6.

    Article  Google Scholar 

  48. 48.

    Warnes C, Honey M, Brooks N, Davies J, Gorman A, Parker N. Mechanical haemolytic anaemia after valve repair operations for non-rheumatic mitral regurgitation. Heart. 1980;44:381–5.

    CAS  Article  Google Scholar 

  49. 49.

    Wilson JH, Rath R, Glaser R, Panke T. Severe hemolysis after incomplete mitral valve repair. Ann Thorac Surg. 1990;50:136–7.

    CAS  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Srirup Chatterjee.

Ethics declarations

Funding

Not required being a review article.

Ethics approval

Not required being a review article.

Human and animal rights

Not required being a review article.

Informed consent

Not required being a review article.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chatterjee, S., Bansal, N., Ghosh, R. et al. Mitral valve repair in children with rheumatic heart disease. Indian J Thorac Cardiovasc Surg 37, 175–182 (2021). https://doi.org/10.1007/s12055-020-00925-0

Download citation

Keywords

  • Mitral valve repair
  • Rheumatic heart disease
  • Annuloplasty
  • Artificial chordae
  • Pericardial patch augmentation