An approach to the surgery of mitral valve disease in children.

Isolated mitral valve surgery was carried out in 182 children under the age of 16 years. Closed valvulotomy was performed in 72, annuloplasty or reconstruction in 10 and valve replacement in 100 of the children. Preoperative atrial fibrillation implied severe disease. Acute rheumatic carditis was not a contraindication to operation. Two patients died after closed mitral commissurotomy and the results were unsatisfactory in nine children with valve calcification and in 12 with a small jet of incompetence. Restenosis occurred in 10 patients during a review period of five years. The long-term results of annuloplasty were disappointing, and this procedure is not recommended for children with mitral incompetence. Ten of the 100 patients who underwent mitral valve replacement died in hospital and there were two late deaths. Seventy-seven patients are completely well and 11 have grade II disability. Severe mitral valve disease in children is associated with high morbidity and mortality, unless normal hemodynamics are restored. Since the results of operation are so satisfactory, we believe that the natural history of this condition is most favorably altered by surgical treatment.