SURGICAL MANAGEMENT OF MITRAL STENOSIS IN PEDIATRIC PATIENTS WITH RHEUMATIC FEVER: A RHEUMATOLOGICAL AND CARDIOVASCULAR PERSPECTIVE

Abstract

Introduction: Mitral stenosis is a common complication in pediatric patients who have developed rheumatic fever, an inflammatory condition that can result from streptococcal infections. Mitral stenosis occurs when the mitral valve does not open properly, leading to impaired blood circulation and, consequently, severe symptoms such as dyspnea and edema. Surgical management is often necessary to restore valve function and prevent long-term complications such as heart failure and arrhythmias. The management of this clinical condition requires an integrated perspective that considers both rheumatological and cardiovascular aspects, since systemic inflammation associated with rheumatic fever can impact the postoperative prognosis. Objective: To analyze the evidence on the surgical approach to mitral stenosis in pediatric patients with rheumatic fever, focusing on clinical outcomes and implications for long-term management. Methodology: The methodology followed the PRISMA checklist and included a search in databases such as PubMed, Scielo, and Web of Science. Five main descriptors were used: “mitral stenosis”, “rheumatic fever”, “pediatric cardiac surgery”, “complications” and “clinical outcomes”. Inclusion criteria included articles that discussed pediatric patients with mitral stenosis secondary to rheumatic fever, publications in English or Portuguese and studies conducted in the last ten years. On the other hand, studies that addressed adults, non-original reviews and studies that did not present significant clinical data were excluded. Results: The results showed that surgery, particularly mitral valvuloplasty, had a high success rate, with most patients experiencing significant improvement in symptoms and quality of life. Postoperative complications were relatively rare, but careful monitoring was considered crucial. Studies have highlighted the importance of early treatment of rheumatic fever to prevent stenosis progression. Conclusion: Surgical management of mitral stenosis in pediatric patients with rheumatic fever has been shown to be effective and safe, with positive long-term results. Multidisciplinary management, integrating rheumatologic and cardiovascular care, was essential to optimize clinical outcomes. In addition, early identification of rheumatic fever and appropriate surgical intervention are essential to improve the quality of life of affected children.