Surgical Treatment of Multivalvular Rheumatic Heart Disease

Of 632 valvular heart disease patients 187 were operated on because of multivalvular rheumatic lesions. The operative mortality was 10.1% and late mortality 4.9%. Left ventricular dysfunction was the common cause in the early operative period. Prosthetic valve endocarditis and thromboembolism were the other common causes of mortality, 5.9% and 6.4% respectively. NYHA Class III-IV, pulmonary hypertension, ejection fraction less than 40%, aortic stenosis and elevated left ventricular end diastolic pressure were significant predictors of poor-prognosis. Tricuspid regurgitation due to right heart decompensation is also another grave sign. The type of the prosthetic valve or additional annuloplasties to double valve replacement did not influence the outcome.

Optimal timing of the operation is essential. Urgent operations should always be avoided if possible. Earlier surgical intervention, improved perioperative myocardial preservation, and alternate support methods, and improved surgical techniques may lower the operative mortality and morbidity.