MITRAL VALVOTOMY IN YOUNG PATIENTS

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Abstract
Mitral valvotomy was performed on 126 patients below 20 years (average 15.5 years). The unusual features were the slight male preponderance, short duration of symptoms, the degree of incapacity, and the low incidence of embolism, atrial fibrillation, and calcification of the mitral valve. Pulmonary hypertension was present in all the patients and in a few who had right heart catheteriza-tion, the pulmonary arterial systolic pressure averaged 81 mm. Hg: in 1 patient it was 150 mm. Hg. The mitral valve was extremely narrowed in the majority of patients. The direct left atrial pressure recorded in 23 patients showed an average left atrial end diastolic pressure of 23 mm. Hg, again reflecting the severe stenosis. The mortality was slightly higher than the usual reports. There was no evidence to attribute this to persisting rheumatic carditis. It was more likely to be related to the severe pulmonary hypertension and poor general condition, as there was a striking increase in mortality in grade 3 and grade 4 patients. The late follow-up showed excellent and good results in 68% and a fair result in 28%. There was an appreciable incidence of rheumatic reactivation in both young and old patients, the great majority of whom were not on long-term chemo-prophylaxis. There was no correlation between the histological evidence of rheumatic activity (atrial biopsy) and rheumatic recurrences. Restenosis was observed in only 1 patient, 4 years after operation. It is concluded that the pattern of rheumatic heart disease in India differs from that in the Western hemisphere in that critical mitral stenosis develops early in a large number of young patients, in whom there are clear indications for early operation.