Current status of surgery for rheumatic carditis in children.
BACKGROUND
The incidence of rheumatic heart disease (RHD) has increased recently in the western United States. We reviewed our 18-year surgical experience with RHD in children to examine current surgical techniques and results.


METHODS
From 1985 until 2003, 596 children (<21 years) with rheumatic fever were seen at Primary Children's Medical Center. Rheumatic carditis was diagnosed in 366 patients (61.4%). Twenty-six with carditis (26/366, 7.1%) required operation for rheumatic valve disease including 8 for mitral regurgitation, 7 for mitral and aortic regurgitation, 4 for aortic regurgitation, 4 for mitral regurgitation and stenosis, 2 for combined mitral stenosis and regurgitation with aortic insufficiency, and 1 for mitral and tricuspid regurgitation.


RESULTS
Mean age at operation was 13.5 +/- 4 years. Three patients required operation during the acute phase of rheumatic fever (< 6 weeks), 2 during the subacute phase (< 6 months), and 21 during the chronic phase after the episode of rheumatic fever (6.7 +/- 3 years). Mitral valve repair was possible in 19 of 22 patients who required mitral operation. Aortic valve repair was possible in 4 patients whereas replacement was necessary in 9, including 2 Ross procedures. No operative deaths were recorded and 2 late deaths occurred at 4.6 and 10 years. Actuarial survival was 94% at 5 years and 78% at 10 years. Six patients required reoperation; actuarial freedom from reoperation was 78% at 5 years, 65% at 10 years, and 49% at 15 years. All survivors are in New York Heart Association class I or II.


CONCLUSIONS
Children with RHD in the United States uncommonly require valve operation. Mitral repair with a technique that allows annular growth is possible in most children with good long-term functional results. Long-term surveillance of children with RHD is necessary because of the possible need for late valve operation.
Division of Cardiothoracic Surgery, Primary Children's Medical Center and the University of Utah, Salt Lake City, Utah 84113, USA. neal.hillman@hsc.utah.edu
Neal D
ND
Hillman
Lloyd Y
LY
Tani
L George
LG
Veasy
Linda L
LL
Lambert
Gregory B
GB
Di Russo
Donald B
DB
Doty
Edwin C
EC
McGough
John A
JA
Hawkins
D000293:Adolescent; D001021:Aortic Valve / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D015993:Life Tables; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography; D014589:Utah / Q000453:epidemiology