ABC | Volume 113, Nº4, October 2019

Original Article Cruz et al. Surgical mitral valvuloplasty in paediatric patients Arq Bras Cardiol. 2019; 113(4):748-756 Table 1 – Characterization of sociodemographic and clinical variables of 54 children and adolescents with rheumatic mitral insufficiency undergoing mitral valvuloplasty Variables Mean ± SD Age (years) 10.5 ± 3.2 Weight (kg) 32.9 ± 14.3 Height (m) 1.4 ± 0.2 Body mass index (BMI) (kg/m 2 ) 15.7 ± 3.5 Median (IQ25–IQ75) Time from disease to surgery (months) 8.00 (5.00–36.00) Sex n (%) Female 29 (53.7) Male 25 (46.3) Origin Countryside 34 (64.2) Salvador 14 (26.4) Metropolitan Region 05 (9.4) Outpatient follow-up Regular 27 (51.9) Irregular 25 (48.1) Cardiac insufficiency NYHA 1 10 (18.5) NYHA 2 22 (40.7) NYHA 3 9 (16.7) NYHA 4 13 (24.1) SD: standard deviation; NYHA: New York Heart Association. Prior to the surgery, 27 (51.9%) had regular outpatient follow‑up. The disease duration until the surgery was a median of 8 months (interquartile range 5-36). The functional classification of 44 (81.48%) patients was between NYHA 2 and 4, with 13 (25%) being NYHA 4. None presented atrial fibrillation or had to undergo emergency surgery. There were no deaths in the sample studied. Only 3 (5.6%) patients had to undergo reoperation, all of them undergoing a single reoperation. The causes were moderate to severe aortic regurgitation, leading to valve replacement in one patient on the 23 rd postoperative day, and the other on the 45 th . The third patient maintained severe MI even after correction, evolving with associated severe aortic insufficiency, undergoing reoperation for aortic and mitral valve replacement on the 45 th day after repair. Preoperative medications were grouped into 4 combinations: combination 1 – captopril and furosemide; combination 2 – captopril, furosemide and spironolactone; combination 3 – captopril, furosemide, spironolactone and digoxin; combination 4 – captopril, furosemide, spironolactone and carvedilol. Of these combinations, approximately half of the patients (55.8%) used combination 1. All patients had regular use of benzathine penicillin. Intraoperative data The patients underwent surgery with a standard surgical team in most cases, with only 2 procedures (3.8%) being performed by another team. The most used surgical technique was annuloplasty (96.2%), followed by commissurotomy 02 (3.8%), considering only the main procedure. There were events during surgery in 24 (44.4%) of the cases, including: severe bleeding (2), CRA (6), use of VAD (8) or others (8). The mean duration of CPB was 62.7 ± 17.8 min and anoxia was 50 ± 15.7 min. Extubation occurred within 6 hours postoperatively in 48 (92.3%) patients. The duration of VAD use in the immediate postoperative period had a median of 1 day (interquartile interval 1–2 days). Description of preoperative and postoperative echocardiograms Table 2 describes the data found in the preoperative and immediate postoperative echocardiogram (up to 7 postoperative days), comparing their results. The postoperative ejection fraction was reduced when compared to the preoperative one, 54.8 ± 13.9% and 70.2 ± 8.5%, respectively, with a value of p < 0.05. As for left chamber dilatation, 98% of the patients presented it preoperative and 87% postoperatively. This reduction showed p = 0.063, demonstrating a trend towards significance. Among the valve changes described in Table 2, moderate or significant aortic insufficiency was present in 13 (26.5%) patients in the preoperative period. In the postoperative period, only 8 (21.1%) had aortic insufficiency, but with no statistical significance (p = 1,000). Moderate or significant MI was present in 48 (98%) patients in the preoperative period. Of these, none of the patients’ MI had worsened and 6 (15.8%) patients maintained moderate or significant postoperative MI (p < 0.001). PH was present in 38 (77.6%) patients in the preoperative period and only 7 (18.4%) in the postoperative period. No patient progressed to PH or worsened in the postoperative period. On the other hand, 31 (81.6%) participants who had preoperative PH did not present it in the postoperative period (p < 0.001). Analysis and description of outcomes The presence of outcomes in the sample was divided into outcomes in the immediate postoperative period (up to 7 days) and in the late postoperative period (up to 60 days), as shown in Table 3. Seventeen patients presented an immediate postoperative outcome, mitral lesion (stenosis and/or residual insufficiency), being present in 8 (14.8%) patients. In the late postoperative period, 16 had outcomes, and mitral regurgitation was again the most common, presented by 11 (20.4%) patients. The comparison between the use of medications in the preoperative period and after discharge and the outcomes did not present statistical significance, regardless of the combination used. The variables that were related to the presence of late postoperative outcome were duration of CPB and duration of 750