LE DOUBLE REMPLACEMENT VALVULAIRE CARDIAQUE POST RHUMATISMALE AU SENEGAL : INDICATIONS ET RESULTATS.

Abstract

Objective: Our aim is to study the epidemiological profile and clinical specificities of aorto-mitral valve diseases and to specify the indications and results (morbidity, mortality) of surgical treatment. Methods: This is a longitudinal, retrospective and descriptive study, which takes place over July 2007 to June 2015 (8 years) at the level of the thoracic and cardiovascular surgery clinic of the university Hospital Center of Fann in Dakar. Our study included twenty-six patients who underwent mitral and aortic valve replacement associated or not with a De Vega tricuspid valve annuloplasty. The mean age was 30 years. Dyspnoea on exertion was the most common functional symptom; found in 18 patients (69 %). On transthoracic ultrasound, the most frequent valve lesions were mitral and aortic insufficiency in 24 patients (92 %). Functional tricuspid insufficiency was noted in 23 patients (88 %). The mean time of cardiopulmonary bypass and clamping was respectively 162 minutes 110 – 343 mn and 123 minutes 86 – 214 mn. Results: Morbidity was mainly hemodynamic complications in 6 patients (23.1 %). The post-operative mortality rate was 15.4%. Moderate to significant preoperative tricuspid insufficiency was a mortality risk factor (p: 0,034). A cardiopulmonary bypass longer than 180 min was also a mortality risk factor (p: 0,029). Conclusion: Mitro aortic valve replacement is associated with high morbidity and mortality. Key words: Mitro aortic valve replacement, rheumatic fever, mortality