Our Summary

This research paper discusses a change in the medical treatment for a serious heart infection in children called infective endocarditis, particularly when it affects the mitral valve in the heart. Previously, the common approach was to replace the damaged valve with a new one. However, there’s a growing trend towards repairing the existing valve instead of replacing it. This can be a challenging procedure, particularly in complex cases, and some hospitals are still hesitant to do it. The paper presents three cases where children with this condition, who also had other factors making their surgery riskier, successfully underwent a complex repair procedure on their mitral valve, which included the use of a supportive “splint” patch.

FAQs

  1. What is the mortality rate of medical management of infective endocarditis in pediatric patients?
  2. What was the traditional surgical management for infective endocarditis of the mitral valve in children?
  3. What is the current trend in treating infective endocarditis of the mitral valve in the pediatric population?

Doctor’s Tip

One important tip a doctor might tell a patient about mitral valve repair is to carefully follow post-operative instructions, including taking prescribed medications and attending follow-up appointments. It is crucial to monitor for any signs of infection or complications, such as fever, chest pain, shortness of breath, or excessive fatigue, and to seek medical attention promptly if any concerning symptoms arise. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help support the long-term success of the mitral valve repair.

Suitable For

Patients who are typically recommended for mitral valve repair include those with infective endocarditis of the mitral valve, particularly in the pediatric population. Patients with complex lesions, high perioperative mortality and morbidity risk factors, and destructive mitral valve endocarditis may also be candidates for mitral valve repair. In these cases, a complex mitral valve repair with “splint” patch plasty of the posteromedial commissure may be performed successfully. Other factors that may influence the recommendation for mitral valve repair include congenital heart disease, valve lesions, and the overall health and condition of the patient.

Timeline

Before mitral valve repair:

  • Patient presents with symptoms such as fever, fatigue, shortness of breath, and chest pain
  • Patient undergoes diagnostic tests such as echocardiogram, blood cultures, and cardiac catheterization to confirm diagnosis of infective endocarditis
  • Patient is started on antibiotics to treat the infection and stabilize their condition
  • Surgery is considered if medical management is not effective or if there is severe damage to the mitral valve

After mitral valve repair:

  • Patient undergoes mitral valve repair surgery, which may involve techniques such as valve repair with a “splint” patch plasty
  • Patient is closely monitored in the intensive care unit post-operatively for any complications
  • Patient undergoes rehabilitation and physical therapy to regain strength and function
  • Patient is followed up with regular cardiac evaluations to monitor the function of the repaired mitral valve and prevent future complications.

What to Ask Your Doctor

  1. What is the reason for recommending mitral valve repair over valve replacement in my case?

  2. What are the potential risks and complications associated with mitral valve repair surgery?

  3. What is the expected recovery time and rehabilitation process after mitral valve repair surgery?

  4. Will I need to take any medications or make lifestyle changes following the surgery?

  5. How frequently will I need follow-up appointments and monitoring after the mitral valve repair surgery?

  6. What is the long-term outlook for my mitral valve function after the repair surgery?

  7. Are there any specific precautions or restrictions I should be aware of after the mitral valve repair surgery?

  8. What is the success rate of mitral valve repair surgery in patients with similar conditions to mine?

  9. Are there any alternative treatment options or second opinions I should consider before proceeding with mitral valve repair surgery?

  10. What is the experience and expertise of the surgical team in performing mitral valve repair surgeries, particularly in pediatric cases like mine?

Reference

Authors: Gritti M, Ferris A, Shah A, Bacha E, Kalfa D. Journal: World J Pediatr Congenit Heart Surg. 2019 Jan;10(1):121-124. doi: 10.1177/2150135117751914. Epub 2018 Aug 21. PMID: 30126326