Rheumatic mitral insufficiency in children: Course, prognosis and effect of mitral valve replacement

Abstract

When the heart is involved as a result of rheumatic fever in children, mitral insufficiency is the most common lesion. Significant mitral stenosis, though it does occur, is not common in this age group. Twenty-eight children with rheumatic mitral insufficiency were divided into 3 groups of severity according to symptoms and heart size. Cardiac volume index and cardiothoracic ratio were compared as indexes of heart size in these patients. The course and prognosis were studied in each group by using cardiac volume index, cardiothoracic ratio, electrocardiographic, phonocardiographic, hemodynamic and clinical data as parameters of severity. In severe cases the course is one of progressive deterioration with development of atrial fibrillation or left atrial and right ventricular hypertension, or both. This course was illustrated by 8 fatal cases, death occurring between 11.5 and 15.5 years of age. In 2 patients the mitral valve was replaced by a Starr-Edwards valve. The patients are surviving and well, 12 and 17 months later. Guides are suggested for the selection of patients with mitral insufficiency for mitral valve surgery.