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Repair of Parachute and Hammock Valve in Infants and Children: Early and Late Outcomes
Eva Maria Delmo Walter1, Mariano Javier1, Roland Hetzer1
1Trauma Surgery Centre Berlin, Berlin Germany.
Insights
Mitral valve repair for parachute and hammock valves in children is complex. While valve-preserving techniques were used, reoperation and mortality risks, especially in infants, highlight the need for ongoing monitoring and potential repeat procedures.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Mitral Valve Repair
Background:
- Parachute and hammock valves are challenging congenital heart malformations requiring surgical correction.
- These conditions can lead to significant mitral valve dysfunction, impacting pediatric cardiac health.
Purpose of the Study:
- To report institutional experience with valve-preserving repair techniques for parachute and hammock valves in pediatric patients.
- To evaluate the early and late surgical outcomes, including survival and reoperation rates.
Main Methods:
- Retrospective review of 20 pediatric patients (1990-2014) with parachute (n=12) or hammock (n=8) valves undergoing mitral valve repair.
- Specific repair techniques included annuloplasty, commissurotomy, and leaflet/ventricular wall modifications tailored to valve type.
- Follow-up duration ranged from 2.7 to 21.4 years.
Main Results:
- Parachute valves predominantly presented with stenosis, while hammock valves showed insufficiency.
- Long-term follow-up revealed cumulative survival rates of 43.7% for parachute valves and 72.9% for hammock valves.
- Freedom from reoperation was 53.0% for parachute valves and 30.0% for hammock valves.
- Age under 1 year was identified as a significant risk factor for reoperation and mortality.
Conclusions:
- Valve-preserving repair for parachute and hammock valves in children is feasible but associated with significant long-term risks.
- Repeat mitral valve repair may be necessary due to the complex nature of these malformations.
- Infants undergoing these repairs face a higher risk of mortality and reoperation, underscoring the need for specialized care.
Abstract:
Parachute and hammock valves in children remain one of the most challenging congenital malformations to correct. We report our institutional experience with valve-preserving repair techniques and the early and late surgical outcomes in parachute and hammock valves in infants and children. From January 1990-June 2014, 20 infants and children with parachute (n = 12, median age = 2.5 years, range: 2 months-13 years) and hammock (n = 8, median age = 7 months, range: 1 month-14.9 years) valves underwent mitral valve (MV) repair. Children with parachute valves have predominant stenosis, whereas those with hammock valves often have predominant insufficiency. Intraoperative findings included fused and shortened chordae with single papillary muscles in children with parachute valves. MV repair was performed using annuloplasty, commissurotomy, leaflet incision toward the body of the papillary muscles, and split toward its base. Children with hammock valves have dysplastic and shortened chordae, absence of papillary muscles with fused and thickened commissures. MV repair consisted of carving off a suitably thick part of the left ventricular wall carrying the rudimentary chordae. The degree and extent of incision and commissurotomy is determined by the minimal age-related acceptable MV diameter to avoid mitral stenosis. During a median duration of follow-up of 9.6 years (range: 6.4-21.4 years), cumulative survival rate and freedom from reoperation in parachute valves were 43.7 ± 1.6% and 53.0 ± 1.8%, respectively. In hammock valves, during a median duration of follow-up of 6.7 years (range: 2.7-19.4 years), cumulative survival rate and freedom from reoperation was 72.9 ± 1.6% and 30.0 ± 1.7%, respectively. Age less than 1 year proved to be a high-risk factor for reoperation and mortality (P < 0.005). In conclusion, children with parachute and hammock valves, repeat MV repair may be necessary during the course of follow-up. Infants have a greater risk for reoperation and mortality.
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