Rheumatismal lesions of the mitral valve a!I'e rare under the age of six and surgical irutervention in symptomatic patients is an academic problem. Early surgical treatment has been done to prevent serious changes and unreversib1e complications o.f the heart and lungs.
From April 71 until April 74, thirty-five patient, ranging between 8-18 years of age, suffering of <lifferents heart ,troubles were admitted in the ward of Cardiac Surgery, Pahlavi Hospital University orf Tehran (23 Female and 12 Male).
Twenty of them had only pure M.S. and thlr-teen M.I. In the recent group, some of them had mixture of M.I. + M.S. There was one case of M.S. plus T.I. and another case M.S. + M.I. plus A.S. plus T.S. + T.I.
After complete medical treatment surgical operations were performed as follow:
Twenty close mitral commissurotomy and one open mitral commissurotomy in pati-ents with pure M.S.
Fourteen other patients were operated on under cairdiapulmonary by-pass and open heart technic.
In two of them mitral annuloplasty was done for M.I. and in twelve others m1tral valve replacement with artificial valve was performed. In those cases ,vith A.S. and T.S. + T.I., repadr of the valve without replacement was done.
In the group with mitral valve replacemen,t there were three mortality cases two of them due severe and uncontrolable post operation bleeding and the other one due fo respiratory insufficiency who died eighteen hours after opera,tion.
The result of close mitral commissurotomy is related to several factors s-uch as myocardial lesfous, anatomic situation o.f 1the valve, presence or absence of pulmonary hypertension, lesions ·of the other valves and quality of the operation.
Over-all the results o-f close mitral commissurotomy are good, although some of them should be reoperated on latter. The results of two annuloplasty were satisfactory. The results of twelve mitral valver replacement except three mortality cases, were good.