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Repair of congenitally malformed mitral valve in children
G Stellin1, U Bortolotti, A Mazzucco
1Department of Cardiovascular Surgery, University of Padova Medical School, Italy.
Insights
Surgical repair of congenital mitral valve disease in children is effective. Mitral valve reconstruction offers a reliable alternative to valve replacement, leading to good long-term outcomes.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Congenital Heart Disease
Background:
- Congenital mitral valve disease presents significant challenges in pediatric patients.
- Surgical intervention is often necessary for managing these complex conditions.
Purpose of the Study:
- To evaluate the outcomes of surgical treatment for congenital mitral valve disease in children.
- To compare the efficacy of mitral valve reconstruction versus replacement.
Main Methods:
- Retrospective review of 30 pediatric patients (<15 years) undergoing surgery for congenital mitral valve disease between 1972 and 1986.
- Analysis of surgical techniques (reconstruction vs. replacement), in-hospital and late mortality, and long-term functional status.
- Postoperative assessment including echocardiography to evaluate valve function and pulmonary artery pressure.
Main Results:
- Mitral valve reconstruction was successful in 87% (26/30) of patients; 4 required valve replacement.
- In-hospital mortality was 16.6% (5/30), with most deaths occurring after conservative operations.
- Long-term follow-up showed 22 of 24 patients were asymptomatic, with echocardiographic evidence of good valve function and normal pulmonary artery pressures.
Conclusions:
- Mitral valve reconstructive procedures are effective and reliable for congenital mitral valve dysplasia in children, even with severe malformations.
- Mitral valve repair is preferred over prosthetic replacement in the pediatric population to avoid prosthesis-related complications.
- Attempting mitral valve repair should be the primary surgical strategy for children with congenital mitral valve disease.
Abstract:
We report our experience with 30 children under 15 years of age treated surgically for congenital mitral valve disease from March 1972 to July 1986. Valve reconstruction was possible in 26 patients (87%), whereas in four the valve was replaced with a mechanical prosthesis. Five patients died in the hospital (16.6%), four after conservative operations and one after mitral valve replacement. There was only one late death in a child in chronic congestive heart failure. Three patients, treated conservatively, required valve replacement 2, 22, and 24 months, respectively, after the operation. Follow-up data reveal that 22 of 24 patients are asymptomatic 5 months to 15 years after operation. Two-dimensional echocardiographic studies were performed in 19 patients treated conservatively, 17 of whom are asymptomatic. Eleven of them have no signs of mitral regurgitation or stenosis, six show only mild mitral incompetence, and two have moderate mitral regurgitation or stenosis. Peak pulmonary artery pressure is within normal limits in all. Our results indicate that mitral valve reconstructive procedures for congenital valve dysplasia may be effective and reliable in children despite the frequent severity of valve malformation. Although no major prosthesis-related complications were observed in the present series, we believe that mitral valve repair should always be attempted in the pediatric population to avoid the drawbacks of the currently available prostheses.