Surgery for rheumatic valvulopathy in children: what we learned from the experience of a public hospital in a developing country

  • Dr Vinicius Nina, University Hospital of The Federal University of Maranhão, São Luis-MA, Brazil, Brazil
  • Dr Rachel Haickel Nina, University Hospital of The Federal University of Maranhão, São Luis-MA, Brazil, Brazil
  • Ms Danila Pacheco, University Hospital of the Federal University of Maranhão, São Luis-MA, Brazil, Brazil
  • Mr Leonardo Carneiro, University Hospital of the Federal University of Maranhão, São Luis-MA, Brazil, Brazil
  • Mr carlos Eduardo Machado, University Hospital of the Federal University of Maranhão, São Luis-MA, Brazil, Brazil
  • Mr Hilton Guimarães Jr, University Hospital of the Federal University of Maranhão, São Luis-MA, Brazil, Brazil
  • Mr Diego Rafael Leite, University Hospital of the Federal University of Maranhão, São Luis-MA, Brazil, Brazil
  • Ms Karina Luz, University Hospital of the Federal University of Maranhão, São Luis-MA, Brazil, Brazil

    • Objective: To analyze the surgical outcomes of rheumatic valvular heart disease in children assisted in a public south-american hospital.
    Methods: from January 2003 through June 2008 a retrospective study was performed with 50 children(33 female) with mean age of 13.4 years and mean weight of 35.9 Kg who were submitted to surgical treatment of rheumatic valvular heart disease; of whom 37 had univalve (4 reoperations) and 13 multivalve disease. Operations were performed under cardiopulmonary bypass and consisted on insertion of a bioprosthesis in 72% (36), valvuloplasty in 22%(11), mechanical valve implant in 4%(2) and a combined procedure in 2%(1).Logistic regression model was applied to identify predictors of mortality.
    Results: in-hospital mortality was 10% (5 cases). There were no late deaths. The average bypass and cross-clamp times were 109.1 and 63.6 minutes respectively. The mean length of hospital stay was 15.7 days. The morbidity rate was 40%. The major morbid events were: bleeding(8), hypotension(4) and arrhythmia(3). Multivariate analysis showed that preoperative heart failure, age under 11 years and weight under 28Kg were independent risk factors for mortality in this population(p<0.05).
    Conclusion: rheumatic heart disease in children is a multifaceted and challenging malady specially when requires an operation because other factors rather than the pathology itself may interfere in the outcome such as: demography(age/weight) and socio-economic status.