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Early and late results of reconstructive operation for congenital mitral regurgitation in pediatric age group
1Department of Cardiovascular Surgery, Tenri Hospital, Nara, Japan.
Insights
Mitral valve reconstructive surgery in children with congenital mitral regurgitation showed a 17-year survival rate of 88.4%. While valvuloplasty had a high failure rate, reoperation-free survival remained favorable.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Valvular Heart Disease
Background:
- Congenital mitral regurgitation (CMR) presents unique challenges in pediatric patients.
- Surgical reconstruction aims to preserve native valve function in children.
Purpose of the Study:
- To evaluate the long-term outcomes of mitral valve reconstructive operations in children with CMR.
- To assess survival rates, valvuloplasty failure, and reoperation rates.
Main Methods:
- Retrospective analysis of 66 children (8 months-15 years) undergoing mitral reconstruction for CMR (1969-1987).
- Surgical techniques included asymmetric annuloplasty, leaflet plication, and cleft/perforation closure.
- Follow-up data analyzed for survival, valvuloplasty failure, and reoperation.
Main Results:
- Operative mortality was 1.5% (1 death).
- Late mortality was 6.0% (4 deaths) over an average follow-up of 5.7 years.
- Actuarial survival was 93.1% at 7 years and 88.4% at 17 years.
- Freedom from valvuloplasty failure was 44% at 15 years; 1 patient required mitral valve replacement.
- Freedom from reoperation was 86% at 17 years.
Conclusions:
- Mitral valve reconstruction in children with CMR offers favorable long-term survival.
- While valvuloplasty failure is common, reoperation rates are relatively low, suggesting reconstructive approaches are viable.
- Further strategies may be needed to improve long-term valvuloplasty durability.
Abstract:
Sixty-six children aged between 8 months and 15 years (average age 5.5 +/- 3.8 years) underwent mitral reconstructive operations for congenital mitral regurgitation between June 1969 and February 1987. The pathologic findings of the mitral valves were annular dilatation in 37 patients, cleft of the leaflet in eight, hypoplasia of the leaflet in 44, perforation of the leaflet in one, chordal elongation in 22, chordal absence in 16, and chordal shortening in seven. The methods of repair consisted of asymmetric annuloplasty (Kay-Reed method) in 61 patients, De Vega-type annuloplasty in one, plication of redundant leaflet in 15, and closure of cleft or perforation in nine. The single operative death (1.5%) was due to heart block. Follow-up data were available over 373.8 patient-years (average 5.7 years). The four late deaths (6.0%) were due to heart failure in two patients, pneumonia in one, and hepatitis in one. The actuarial survival rate was 93.1% +/- 3.1% at 7 years and 88.4% +/- 5.1% after 17 years. Valvuloplasty failed in 19 of the long-term survivors. One of these patients underwent mitral valve replacement 11 years after initial operation. The rate of freedom from reoperation was 86% +/- 10% after 17 years. The rate of freedom from valvuloplasty failure was 80% +/- 6.7% after 5 years, 67% +/- 7.2% after 10 years, and 44% +/- 11.9% after 15 years.