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Left ventricular apical approach for the surgical treatment of congenital mitral stenosis
M Barbero-Marcial1, A Riso, A T De Albuquerque
1Heart Institute, University of São Paulo Medical School, Brazil.
Insights
Surgical correction of congenital mitral valve stenosis in infants and children yielded zero operative mortality. Postoperative studies showed no significant residual stenosis and normal left ventricular function in most patients.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Congenital Heart Disease
Background:
- Congenital mitral valve stenosis is a rare but serious condition in infants and children.
- Surgical intervention is often necessary to relieve obstruction and improve cardiac function.
- Previous surgical approaches have had varying degrees of success and associated risks.
Purpose of the Study:
- To evaluate the safety and efficacy of a specific surgical technique for congenital mitral valve stenosis.
- To assess the long-term outcomes, including mortality and left ventricular function, after surgical correction.
Main Methods:
- A retrospective review of 12 patients with congenital mitral valve stenosis who underwent surgical correction between June 1987 and October 1991.
- Surgical correction involved an apical left ventriculotomy with subvalvular and valvular obstruction removal, including papillary muscle splitting and chordal division/fenestration.
- Commissurotomies were performed from the ventricular aspect, with simultaneous correction of associated anomalies.
Main Results:
- Zero operative mortality was observed in the 12 patients.
- One late death occurred, unrelated to cardiovascular status.
- Serial echocardiographic studies up to 52 months showed no significant residual mitral stenosis and normal global and regional left ventricular function in all but one patient.
Conclusions:
- Apical left ventriculotomy is a safe and effective surgical approach for congenital mitral valve stenosis in pediatric patients.
- This technique can achieve excellent long-term results with minimal residual stenosis and preserved left ventricular function.
- Simultaneous correction of associated anomalies is crucial for optimal patient outcomes.
Abstract:
From June 1987 to October 1991, 12 patients with congenital mitral valve stenosis underwent surgical correction. Their ages ranged from 2 to 74 months. Nine patients were less than 22 months of age. Five patients were in New York Heart Association functional class IV, and seven patients were in class III. In nine, parachute-type mitral stenosis was clearly definite. In three, a complex congenital valvular and subvalvular stenosis was found. Associated anomalies were present in every patient; five had undergone previous operations. Correction of the mitral stenosis was done through an apical left ventriculotomy. The removal of the mitral obstruction starts from below; the papillary muscle was split and the chordae were divided or fenestrated. The commissurotomies were performed from the ventricular aspect of the mitral valve. Associated anomalies were corrected simultaneously. The operative mortality rate was zero. There was one late death, which was unrelated to cardiovascular status. The echocardiographic serial postoperative studies (up to 52 months) showed no significant residual mitral stenosis and normal global and regional function of the left ventricle in all but one patient.