Mitral valve repair may be performed without ring support with advantages related to results and complications. The objective of this study was to analyze the long-term clinical results following surgical repair and reconstruction without the use of rings in cases of congenital mitral lesions in children less than 12 years of age. Twenty-one patients who had undergone surgery during the period from 1975 to 1998 were evaluated. The mean age was 4.6 +/- 3.4 years. Females represented 47.6% of the total. Mitral regurgitation was present in 57.1% (12 patients), stenosis in 28.6% (6 patients), and the mixed lesion group represented 14.3% (3 patients). Perfusion time was 43.1 +/- 9.5 minutes and ischemic time 29.4 +/- 10.5 minutes. Follow-up time was 41.5 +/- 53.6 months for the regurgitation group, 46.3 +/- 32.0 months for the stenosis group, and 39.41 +/- 37.51 months for the mixed lesion group. Echocardiographical follow-up time was 37.17 +/- 39.51 months for the regurgitation group, 42.61 +/- 30.59 months for the stenosis group, and 39.41 +/- 37.51 months for the mixed lesion group. Operative mortality was 9.5% (two cases). There were no late deaths. In the regurgitation group, 10 patients (83.3%) were asymptomatic (p = 0.004). In the echocardiographical follow-up, most of the patients had minimal regurgitation. In the clinical follow-up of the stenosis group all patients were in functional class I (NYHA). The mean transvalvular gradient measured by echocardiography was from 8 to 12 mmHg with a mean gradient of 10.7 mmHg. In the mixed lesion group there was one reoperation at postoperative month 43. There were no cases of endocarditis or thromboembolism. Mitral valve repair in congenital lesions is associated with good late results. The majority of cases in the regurgitation group remain asymptomatic and do not require reoperation. Rings or annular support are not necessary in such cases. Satisfactory repair is more difficult to achieve in cases of mitral stenosis due to valvular abnormalities and the seriousness of the associated lesions.

Child↗

PubMedDate not supplied

[Reduction of pressure gradients and of ventricular hypertrophy after surgical valvoplasty in aortic stenosis].

BACKGROUND: Relief of gradient is followed by myocardial mass reduction in aortic stenosis. Its degree and speed are under evaluation. Aortic valve repair in calcified aortic stenosis is less well studied than replacement. METHODS: We evaluated left ventricular hypertrophy reduction by echocardiogram in 11 patients immediately after valve repair in aortic stenosis at a mean of 6.1 +/- 0.9 days post operative. RESULTS: Septal width was 12.10 +/- 1.66 mm pre and 11.36 +/- 1.12 mm post operative, 6,1% reduction (NS). Parietal width varied 4.4% from 11.70+/-1.41 mm to 11.18 +/- 1,16 mm (NS). Ejection fraction went from 62.02+/-18.59% to 62.50+/-11. 74% (NS). Left ventricular mass varied 6.7%, from 277.65+/-114.80g to 258.93+/- 92.38 g (NS). Mean transvalvar gradient reduced 57%, from 53.56+/-10.30 to 23.0+/-9.1 mmHg (P<0.001). CONCLUSION: Aortic valve repair reduces gradients adequately and left ventricular hypertrophy shows a trend to regression soon after aortic repair, but is not yet significant in the first post-operatively week.

Aged↗

PubMedDate not supplied

[Countercurrent aortography by contrast injection into a peripheral artery].

Countercurrent aortography performed through left brachial artery in 8 children, aging 27 days to 42 months. Systemic-pulmonary anastomosis was possible to be assessed in 3 out of 4 cases, even in one aging 42 months. Aortic coarctation could be evaluated in another 3 patients. In the last case with a clinical suspection of vascular ring, countercurrent aortography disclosed an anomalous right subclavian artery. We concluded that the procedure is safe and useful to assess some conditions involving thoracic aorta, even in older children.

Aorta, Thoracic↗