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[Clinical results of mitral valve surgery in children]
Insights
Pediatric mitral valve surgery shows promise, with valve plasty achieving high success rates for regurgitation. However, mitral stenosis surgery results remain unsatisfactory, indicating a need for improved pediatric cardiac surgical techniques.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Surgery
- Congenital Heart Disease
Background:
- Mitral valve disease in children presents significant challenges.
- Surgical outcomes for pediatric mitral valve regurgitation and stenosis vary.
- Evaluating clinical results is crucial for improving pediatric cardiac surgical care.
Purpose of the Study:
- To evaluate the clinical outcomes of mitral valve surgery in pediatric patients.
- To assess the efficacy of different surgical techniques for mitral regurgitation and stenosis.
- To identify areas for improvement in pediatric mitral valve surgery.
Main Methods:
- Retrospective analysis of 50 children undergoing mitral valve surgery for regurgitation.
- Analysis of 10 children undergoing mitral valve surgery for stenosis.
- Evaluation of surgical techniques including valve plasty, annuloplasty, and valve replacement.
- Assessment of operative mortality, reoperation rates, and long-term survival.
Main Results:
- Mitral valve regurgitation surgery had low operative mortality (2%) and high valve plasty success (92%).
- Reconstructive chordae tendineae techniques achieved 100% mitral repair success for anterior leaflet prolapse.
- Mitral stenosis surgery showed unsatisfactory results with high valve replacement rates (50%) and mortality (20%).
- 15-year reoperation-free and survival rates for mitral regurgitation were 70% and 85%, respectively.
- 2-year reoperation-free and 13-year survival rates for mitral stenosis were 42% and 32%, respectively.
Conclusions:
- Pediatric mitral valve plasty is effective for regurgitation, especially with reconstructive techniques.
- Surgical outcomes for pediatric mitral stenosis remain suboptimal, necessitating further research and technique development.
- Long-term follow-up demonstrates favorable survival for mitral regurgitation repair in children.
Abstract:
The clinical results of mitral valve surgery in children were evaluated. Fifty children (age ranged between 1 month and 12 years) with mitral valve regurgitation have undergone valve surgery with low operative mortality (2%). Valve plasty using several techniques including annuloplasty have been performed with quite high success rate (92%), while valve replacement was required in four patients who had the prolapse of the anterior mitral leaflet (8%). Reoperation was required in 5 patients (10%), and there were 4 late deaths. Introduction of the reconstructive technique of the chordae tendinae using artificial chordae resulted 100% success rate of mitral repair for the prolapse of the anterior mitral leaflet without death and reoperation. The reoperation free rate and the actuarial survival rate at 15 years of the patients with mitral regurgitation were 70 +/- 12% and 85 +/- 7%, respectively. In ten patients with mitral valve stenosis (age ranged between 1 month and 5 years), 5 patients required valve replacement (50%), and 2 patients died (20%). The clinical results of the surgery for the mitral stenosis were still unsatisfactory, and the reoperation free rate at 2 years was 42 +/- 30% and the actuarial survival rate at 13 years were 32 +/- 18%.