Related Experiment Video
Updated: Jun 4, 2025
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Moderate mitral regurgitation in association with ventricular septal defect in children: Does it warrant mitral valve
Hao Siang Ong1, Sivakumar Krishnasamy2, Retnagowri Rajandram1
1Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
Insights
For pediatric patients with ventricular septal defect (VSD) and moderate mitral regurgitation (MR), mitral valve repair (MVr) may improve survival. Surgical intervention on the mitral valve (MV) shows a trend toward better outcomes in VSD with moderate MR.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Congenital Heart Defects
Background:
- Management of VSD with concurrent MR in pediatric patients is complex.
- Guidelines for moderate MR in VSD patients are lacking.
- MR regression post-VSD closure is observed, but MV management remains debated.
Purpose of the Study:
- To explore factors influencing MV management in VSD patients with moderate MR.
- To compare outcomes between surgical intervention and conservative MV management.
- To identify optimal strategies for this specific pediatric subgroup.
Main Methods:
- Retrospective cohort study (2000-2015) of 53 pediatric patients with VSD and moderate MR.
- Patients stratified by MV pathology and intervention status.
- Analysis of surgical outcomes including mortality and re-operation rates.
Main Results:
- No significant preoperative differences between groups, except longer cross-clamp time in one intervention group.
- Intervention groups trended towards higher survival rates, though not statistically significant.
- Shorter cross-clamp duration correlated with reduced mortality.
Conclusions:
- Mitral valve repair (MVr) in VSD with moderate MR and valvular pathologies may improve survival without increasing morbidity.
- Surgical MVr shows a better survival trend for moderate MR with isolated annular dilatation compared to no intervention.
Background:
The management of ventricular septal defect (VSD) alongside mitral regurgitation (MR) in pediatric patients remains a contentious issue due to the intricacies of cardiac surgery and the need to minimize ischemic time. Despite observations of MR regression following VSD closure, definitive guidelines for this patient subset are lacking, particularly concerning the management of the subgroup of patients with moderate MR. The objective of the study is to explore the factors influencing the choice between surgical intervention and conservative management for the mitral valve (MV) in VSD patients with moderate MR.
Materials And Methods:
A retrospective cohort study from January 2000 to December 2015, we analyzed management trends and focused on 53 patients with both VSD and moderate MR. This cohort was subdivided into four groups: first by their MV pathology, and then stratified by the receipt of intervention towards the diseased MV. Our primary goal was to identify correlations, especially concerning surgical outcomes such as mortality and need for re-operation. Statistical significance is determined when the P value is lower than 0.05.
Results:
There were no notable differences in preoperative variables across four cohort groups, apart from the cross-clamp duration which was longest in Group B intervention. Outcome analysis showed survival rates that were higher in cohort groups that underwent intervention toward the disease MV regardless of existing MV morphology, although results were not statistically significant. Cox model analysis found no correlation between the cohort groups and postoperative outcomes, but cross-clamp duration significantly correlated with mortality.
Conclusions:
In cases of VSD with moderate MR with associated pathologies of the valvular apparatus, opting for MV repair (MVr) appears to improve survival outcomes without significantly increasing postoperative morbidity. Similarly, for patients with moderate MR and isolated annular dilatation, surgical MVr is observed to have better survival trend compared to the control group.
Related Concept Videos
01:25Mitral Regurgitation III: Medical Management
01:20Mitral Regurgitation I: Introduction
01:22Mitral Stenosis I: Introduction
01:28Mitral Regurgitation IV: Nursing Management
01:27Mitral Valve Prolapse I: Introduction
01:19Mitral Valve Prolapse III: Nursing Management