Mitral stenosis in childhood: Clinical and therapeutic aspects

Abstract

Fifty-four patients with mitral stenosis, aged 8 to 15 years, are reported on. The symptomatology was constantly quite severe and all patients, except one, belonged to functional Classes III and IV. The electrocardiogram showed normal sinus rhythm in all, left atrial hypertrophy in 74 per cent, and right ventricular hypertrophy in 63 per cent. Radiologic heart size was only moderately increased in most cases. Catheterization of the right side of the heart, performed in 27 patients, revealed a high percentage of marked pulmonary hypertension, arteriolar resistance being relatively low in respect to total pulmonary resistance. Two patients were discharged, one because of acute endocarditis, the other because of normal hemodynamic data. Four patients died before operation. The other 48 patients underwent mitral valvotomy. At operation the valve was found to be markedly stenotic in most cases. There were no valvular calcifications. Valvotomy was estimated to be satisfactory in 96 per cent of the cases. In 4 patients, slight to moderate insufficiency was created. There was no operative mortality; one patient died 35 days after operation.

Late postoperative clinical information was available in 38 patients, with a duration of follow-up from 1 to 8 years. Four patients died, after 1, 2, 5, and $\text{5}\text{1}\text{2}\text{years}$. As for the other 34 patients, the clinical result was excellent in 17 and good in 13. One patient showed only slight improvement. After a period of initial benefit in 3 patients, there was a recurrence of symptoms, complete in one due to restenosis, partial in the others. The ECG showed regression of right ventricular hypertrophy in most cases, whereas the radiologic appearance remained mostly unchanged. There was only one instance of frank rheumatic reactivation.

It is believed that mitral commissurotomy is clearly indicated in the childhood group, except in cases of acute carditis and/or overt cardiac failure.