Experience with mitral valve surgery after percutaneous mitral commissurotomy.

Abstract

In this issue, Antunes and coworkers present their experience with mitral valve surgery after percutaneous mitral valve commissurotomy (PMC) [1]. The patient material includes 61 patients with rheumatic mitral valve disease who have undergone PMC on average 6.9 years earlier. The results from surgery are very satisfying and mitral valve repair was accomplished in 38 patients (62%). The mean age of the patients was 52 years. Long-term results are still lacking but the 10-year follow-up is promising. Rheumatic fever is still a widespread disease, especially in developing countries, where it remains endemic in some areas. If not properly treated, more than 50% of those infected will develop rheumatic heart disease (RH), most commonly affecting the mitral valve. In the early phase of RH, mitral insufficiency dominates, but later on mitral stenosis is a common end result for the mitral valve [2, 3]. RH is today the leading cause of heart failure in children and young adults worldwide, with large consequences in terms of disability and reduced working capacity in developing nations. RH causes more than 250 000 premature deaths annually. It has been estimated that up to 20 million people are affected by the disease today, in addition to an unknown number of cases of sub-clinical valve disease that can be of clinical significance later, and can be diagnosed by echocardiographic screening. In spite of the socioeconomic changes in Europe, RH is still contributing to about 20% of all valve disease in the area [4]. However, it is rare today in northern Europe. It is well established that the disease can be prevented by socioeconomic progress, aggressive prophylaxis and treatment with antibiotics. Unfortunately, RH has often been neglected by the medical community, as evidenced by a relatively low number of scientific reports. It is difficult to find an estimate of the number of patients needing an intervention or surgical procedure worldwide. But aside from the obvious need for limiting the disease and for antibiotic prophylaxis, there will be an increasing demand on resources for interventional and surgical treatment of patients severely affected by the disease. The work of professor Antunes is of great importance, confirming that many of the patients in need of surgery can be treated with valve-sparing procedures. It is recognized that it takes both experience and skill to achieve such results. It should be kept in mind that many of the patients are young and can be expected to plan for pregnancy and to have the need for optimal working capacity. Living in a developing country with limited social security and having the burden of heart failure at a young age is a catastrophe. However, many questions still need to be considered.