A case of severe rheumatic mitral insufficiency in a 12-year-old boy invalided by chronic congestive heart failure and atrial fibrillation who was strikingly improved by mitral annuloplasty is described. The clinical course and cardiac catheterization findings before and after operation are outlined.
Indications for surgical relief of mitral insufficiency in the pediatric patient have been suggested. The problem of optimum timing of surgery after subsidence of acute rheumatic carditis is unsolved. Each case must be carefully evaluated. The case presented was less than two years from overt rheumatic activity at the time of surgery. We hope this case stimulates surgical consideration for the child with severe rheumatic mitral insufficiency since earlier operation in appropriate instances may prevent the onset of atrial fibrillation and progressively diminishing myocardial reserve.