Rheumatic mitral stenosis at Siriraj Hospital. IV. data from the young age group

Abstract

From 1964 through 1967, 303 patients suffering from rheumatic mitral stenosis were submitted for mitral valvulotomy at Siriraj Hospital. Of these patients, 32 or 12.5 per cent were 15 years of age or younger. There were 18 boys and 14 girls. Most of them had a history of recent illness with rapid progression of symptoms. There was no atrial fibrillation, no clot in the left atrium nor any history of peripheral embolism in this group. The size of the mitral valve was very small but showed no calcification.  Operative mortality was encountered in only one patient (3%), who had been gravely ill from repeated bouts of acute pulmonary edema in addition to marked jaundice and severe derangement of his liver function. He suffered cardiac arrest in the operating room; his mitral valve measured less than 0.5 cm. in diameter. Postoperative complication developed in one patient, i.e., moderate mitral insufficiency, and his mitral valve was eventually replaced by a Starr-Edwards valve. Re-activation of rheumatic fever occurred in a patient 2 weeks after the operation but he responded satisfactorily to aspirin. All patients who returned for follow-up showed marked improvement in exercise tolerance.