Related Experiment Videos
[Surgery for mitral regurgitation in children]
1First Department of Surgery, Osaka University, Japan.
Insights
Mitral valve repair in children offers better outcomes than replacement, especially regarding reoperation rates and valve growth. However, outcomes are less favorable for patients with partial endocardial cushion defects.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Engineering
Background:
- Mitral valve (MV) repair is preferred over replacement in pediatric patients due to avoidance of anticoagulation and suitability for small children.
- Long-term outcomes of pediatric MV repair remain incompletely understood.
- Mitral regurgitation (MR) management in pediatric populations requires further investigation.
Purpose of the Study:
- To evaluate the long-term outcomes of mitral valve repair versus replacement in pediatric patients.
- To assess reoperation rates and mitral annulus growth following MV repair.
- To identify factors influencing the success of MV repair in children.
Main Methods:
- Retrospective evaluation of 52 pediatric patients undergoing MV repair (n=46) or replacement (n=6) for MR between 1970 and 1996.
- Analysis included patients with associated diseases and those who underwent mitral annuloplasty (Kay or Paneth-Burr methods).
- Comparative assessment of reoperation-free survival and mitral annulus growth.
Main Results:
- Mitral valve repair demonstrated a significantly higher freedom from reoperation rate compared to MV replacement.
- Mitral annulus diameter showed growth within the normal range after MV repair.
- Patients with partial endocardial cushion defect (ECD) had a significantly lower freedom from reoperation rate after MV repair.
Conclusions:
- Mitral valve repair is associated with favorable long-term outcomes, including reduced reoperation rates and appropriate valve growth in pediatric patients.
- MV repair offers advantages over replacement in pediatric populations, except for those with partial endocardial cushion defects.
- Further research is warranted to optimize MV repair strategies for pediatric patients with complex cardiac conditions.
Abstract:
In pediatric patients, mitral valve (MV) repair is preferable than MV replacement because of no need for anticoagulation and its feasibility in small children. However, long-term outcome of MV repair is still unclear. In the present study, fifty-two pediatric patients who underwent MV repair (n = 46) and MV replacement (n = 6) against mitral regurgitation (MR) between January 1970 and December 1996 were evaluated. 46 patients had associated diseases. Mitral annuloplasty was applied in 20 patients (by Kay method (n = 14) and Paneth-Burr method (n = 6) before and after 1991, respectively). Freedom from reoperation rate in patients with partial endocardial cushion defect (ECD) was significantly lower than that in other patients after MV repair, which was significantly higher than that in patients with MV replacement. Diameter of mitral annulus grew within normal range after MV repair. In conclusion, MV repair may provide better outcomes with respect to reoperation and growth of MV in pediatric patients except with partial ECD.