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Anterior mitral leaflet prolapse as a primary cause of pure rheumatic mitral insufficiency
A Kalangos1, M Beghetti, D Vala
1Clinic for Cardiovascular Surgery, Department of Pathology, University Cantonal Hospital of Geneva, Switzerland. afksendyios.kalangos@hcuge.ch
Insights
Mitral valve repair is safe for children with rheumatic mitral regurgitation caused by anterior leaflet prolapse. Techniques yield stable short-term results, with better midterm outcomes in specific patient groups.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Rheumatic Heart Disease
Background:
- Rheumatic mitral regurgitation in children often involves anterior leaflet prolapse.
- Understanding prolapse mechanisms is key to successful mitral valve repair.
Purpose of the Study:
- To revise mechanisms and repair techniques for anterior mitral leaflet prolapse in pediatric rheumatic mitral regurgitation.
- To evaluate the safety and efficacy of mitral valve repair in this specific patient population.
Main Methods:
- Retrospective analysis of 36 children (mean age 12.5 years) with pure rheumatic mitral regurgitation and anterior leaflet prolapse.
- Categorization of prolapse into chordal elongation (Group A), chordal rupture (Group B), and secondary chordae retraction (Group C).
- Application of specific surgical techniques including chordal shortening, transposition, and resection based on prolapse mechanism.
Main Results:
- All patients completed follow-up (mean 3 years).
- Significant improvement in left ventricular and atrial dimensions observed post-repair.
- One late death from endocarditis; two patients in Group C required mitral valve replacement due to repair failure.
Conclusions:
- Mitral valve repair is a safe option for all types of anterior leaflet prolapse in rheumatic mitral regurgitation.
- Short-term results are stable across all groups.
- Midterm outcomes are superior in patients with less tissue thickening, lower rheumatic carditis recurrence, and shorter disease duration (Groups A & B).
Background:
This study was designed to revise the mechanisms and repair techniques of anterior mitral leaflet prolapse observed during the correction of pure rheumatic mitral regurgitation in children.
Methods:
From March 1993 to May 1998, 36 children suffering from pure rheumatic mitral regurgitation due to anterior leaflet prolapse underwent mitral valve repair. The mean age was 12.5 years (range, 6 to 16 years). Anterior leaflet prolapse was due to chordal elongation in 25 patients (group A), chordal rupture in 6 patients (group B), and retraction of anterior secondary chordae tendineae, creating a V-shaped deformity in the middle of the anterior leaflet, thus moving the free edge of the anterior leaflet away from the coaptation plane, in 5 patients (group C). Chordal shortening, transposition, and resection of anterior secondary chordae tendineae were used to correct anterior leaflet prolapse according to the predominantly responsible mechanism.
Results:
All patients were available for clinical follow-up, which ranged from 6 months to 5 years (mean follow-up, 3 years). Echocardiographic studies were obtained until the 3rd postoperative month, and all patients showed significant improvement in their left ventricular and atrial dimensions. There was one late death related to endocarditis. Two patients in group C who had mitral valve repair underwent mitral valve replacement on the 19th and 24th postoperative months, respectively, because of failure of mitral valve repair.
Conclusions:
Mitral valve repair for pure mitral regurgitation due to rheumatic anterior leaflet prolapse can be performed safely for all types of mechanisms. Although the techniques we used provide stable short-term results in each of these groups, midterm results are better in groups A and B, where tissue thickening is less important, recurrences of rheumatic carditis are lower, and the interval between the first rheumatic attack and the surgical procedure is shorter than in group C.