VALVE REOPERATION IN PATIENTS WITH A HISTORY OF RHEUMATIC FEVER: ANALYSIS OF POST-SURGICAL COMPLICATIONS AND PERSISTENT CARDIAC MANIFESTATIONS IN CHILDREN AND ADOLESCENTS

Abstract

Introduction: Rheumatic fever, a sequela of streptococcal infections, can lead to rheumatic heart disease (RHD), characterized by progressive inflammatory lesions that primarily affect the heart valves. In children and adolescents, RHD often results in significant valvular stenosis and/or regurgitation, requiring surgical intervention to restore hemodynamic function. However, the inflammatory and progressive nature of RHD, combined with patient growth and the limited durability of prosthetic valves, often implies the need for multiple reoperations throughout life, each presenting its own challenges and additional risks compared to the first surgery. Objective: The objective of this systematic literature review was to analyze the postsurgical complications and persistent cardiac manifestations observed after valve reoperations in pediatric and adolescent patients with a history of rheumatic fever. Methodology: A systematic literature review was performed following the principles of the PRISMA checklist. The search was performed in the electronic databases PubMed, SciELO and Web of Science, using the descriptors: "Valve Reoperation", "Rheumatic Heart Disease", "Pediatrics", "Adolescent" and "Complications". Articles published in the last 10 years that addressed the topic were included. Inclusion criteria consisted of studies involving pediatric or adolescent patients with a history of rheumatic fever who underwent valve reoperation and reported postsurgical complications or persistent cardiac manifestations. Studies focused on first surgeries, exclusively adult patients or with other etiologies of valvular disease were excluded. Results: The studies analyzed indicated that valve reoperations in pediatric and adolescent patients with RHD were associated with a significantly higher risk of perioperative complications, including excessive bleeding, infections and myocardial dysfunction, compared with primary surgeries. Prosthetic durability and anticoagulation management in mechanical valves represented ongoing challenges. Persistent cardiac manifestations after reoperation frequently included progressive dysfunction of other valves, atrial or ventricular arrhythmias, and, in some cases, residual ventricular dysfunction, reflecting the chronic burden of disease and the complexity of repeated interventions. Conclusion: Valvular reoperations in children and adolescents with rheumatic heart disease presented high perioperative risks and were frequently followed by the persistence or development of new cardiac manifestations. This reality highlighted the chronic and progressive nature of RHD in this population, indicating the need for close clinical follow-up and anticipation of future interventions, aiming to optimize long-term outcomes and quality of life.