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Echocardiographic characteristics and outcome of straddling mitral valve
A Fraisse1, P J del Nido, J Gaudart
1Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115, USA.
Insights
Echocardiography reveals diverse straddling mitral valve (SMV) anatomy, aiding surgical decisions. Segmental analysis classifies SMV into four groups, guiding treatment towards univentricular palliation for complex cases.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiac Surgery
Background:
- Limited data exists on echocardiographic features of straddling mitral valve (SMV).
- Understanding preoperative predictors of outcome is crucial for surgical planning.
Purpose of the Study:
- To characterize echocardiographic findings in straddling mitral valve (SMV).
- To determine surgical implications and midterm outcomes for SMV patients.
- To identify preoperative predictors of outcome in SMV.
Main Methods:
- Retrospective review of 46 SMV patients (1982-1999) with echocardiography, surgery, and follow-up.
- Detailed echocardiogram and surgical report analysis.
- Multivariate analysis to identify outcome predictors.
Main Results:
- Echocardiography showed varied SMV anatomy, classifiable into four distinct groups via segmental analysis.
- Cardiac malposition and ventricular anomalies were common in specific segmental combinations.
- Functional single-ventricle palliation was performed in 83% of patients; biventricular repair in 17%.
- Overall mortality was 22%, with no deaths in the last five years of the study.
- Noncommitted ventricular septal defect (VSD) was the strongest predictor of death (RR=10.2).
Conclusions:
- Echocardiography effectively visualizes complex SMV anatomy and associated anomalies.
- Segmental analysis aids in classifying SMV into four morphologically distinct groups.
- Functional univentricular palliation is recommended for severe SMV with hypoplastic ventricles; biventricular repair is feasible in select cases.
Objectives:
This study sought to characterize the echocardiographic features of straddling mitral valve (SMV) and to determine its surgical implications and midterm outcome in a large clinical cohort.
Background:
Despite a relatively large body of literature on the postmortem anatomy of SMV, there is a paucity of information regarding its echocardiographic features, surgical implications and preoperative predictors of outcome.
Methods:
A retrospective review identified 46 patients with SMV between 1982 and 1999 who underwent echocardiography and surgery and had follow-up data. A detailed review of the echocardiograms, surgical reports and all pertinent records was undertaken.
Results:
Review of the echocardiograms revealed a widely varying anatomy among the study patients. However, four distinct groups with relatively uniform morphologic features could be distinguished on the basis of segmental analysis. Cardiac malposition associated with right ventricular hypoplasia, superior-inferior ventricles and criss-cross atrioventricular relations were common among patients with [S,D,L] (S = visceroatrial situs solitus, D = D-ventricular loop, L = L-malposition of the great arteries) (n = 6) and [S,L,D] (n = 5) segmental combinations but were rare among patients with [S,D,D] (n = 26) and [S,L,L] (n = 9) combinations. Surgical management consisted of a functional single-ventricle palliation in 38 patients (83%) and biventricular repair in 8 patients (17%). Overall mortality was 22%, but none of the seven patients who were operated on during the cohort's last five years (1994 to 1999) has died. By multivariate analysis, noncommitted ventricular septal defect was the strongest independent predictor of death (relative risk = 10.2), followed by multiple ventricular septal defects (relative risk = 4.7).
Conclusions:
This study demonstrates that echocardiography provides detailed noninvasive imaging of the complex anatomic features of SMV and its associated anomalies. Anatomic classification based on segmental analysis allows the distinction of four groups with more uniform morphologic features. Although a biventricular approach is feasible in selected patients, a functional univentricular palliation is indicated in those with major straddling and markedly hypoplastic ventricles.