Triple valve repair for young rheumatic patients.
BACKGROUND
Facing young foreign polyvalvular rheumatic patients, for which long-term anticoagulation is not available, we have chosen to attempt triple valve repair procedures in order to avoid prosthetic implantation in this particular population suffering from triple valve disease.


METHODS
Twenty-one young rheumatic patients (mean age:11+/-4 years) underwent triple valve repair procedures including cusp extension on the aortic valve aortic between September, 1992 and December, 2000. Valvular pathology characteristics according to Carpentier's classification included mitral insufficiency type III post+II ant (n=10), type III post (n=4), type II ant (n=2), mitral stenosis (n=5), type III aortic insufficiency (n=21), type I (n=13) and type III (n=8) tricuspid insufficiency.


RESULTS
Firstly, the mitral valve disease were corrected using Carpentier's techniques of repair: prosthetic ring annuloplasty (n=16), commissurotomy (n=12), chord transposition (n=11) or shortening (n=4), papillary muscle sliding plasty (n=4) and pericardial patch leaflet enlargement (n=6). Secondly, aortic lesions were corrected using glutaraldehyde stabilized autologous pericardium triple cusps extension technique (n=21). Lastly, tricuspid repairs were always performed on beating hearts using commissurotomy (n=8), prosthetic ring (n=12) or other techniques (n=9) of annuloplasty. The operative mortality was 4.7% (one patient died). Echocardiograms before discharge showed grade I mitral insufficiency in seven patients and grade I aortic insufficiency in five patients. There was no late death during a mean follow-up of 51+/-31 months. Two patients underwent valvular redo surgery because of aortic and mitral plasty deterioration due to rheumatic disease progress. After 5 years, 90% of the patients were free from redo valvular surgery.


CONCLUSIONS
In rheumatic patients, autologous pericardial patch extension of the aortic valve permitted widespread use of reconstructive surgery even in patients suffering from triple valve disease. Triple valve repair, in this particular challenging setting of patients, has provided satisfactory initial and mid-term results and could be considered as an interesting palliative surgical approach.
Grinda
Jean-Michel
JM
Cardiac Surgery Department, Hôpital Européen Georges Pompidou, Paris University, Paris, France. jean-michel.grinda@egp.ap-hop-paris.fr
Latremouille
Christian
C
D'Attellis
Nicola
N
Berrebi
Alain
A
Chauvaud
Sylvain
S
Carpentier
Alain
A
Fabiani
Jean-Noël
JN
Deloche
Alain
A
D002648:Child; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D012086:Reoperation; D012214:Rheumatic Heart Disease / Q000601:surgery*