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Mitral valve repair for mitral regurgitation with ventricular septal defect in children
K Hisatomi1, T Isomura, T Sato
1Second Department of Surgery, Faculty of Medicine, Kagoshima University, Japan.
Insights
Conservative mitral valve repair in pediatric patients with ventricular septal defect shows good long-term outcomes. Careful follow-up is essential to monitor for mitral regurgitation and stenosis post-repair, especially after bilateral annuloplasty.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Cardiac Valve Repair
Background:
- Study evaluated intermediate and long-term outcomes of conservative mitral valve repair in 25 pediatric patients.
- Patients aged 3 months to 11 years underwent repair for mitral regurgitation associated with ventricular septal defect.
- Procedures performed between April 1973 and March 1991.
Purpose of the Study:
- To assess the efficacy and long-term results of conservative mitral valve repair in children with ventricular septal defect.
- To identify potential complications and the need for reoperation.
- To evaluate the impact of repair techniques on patient outcomes.
Main Methods:
- Retrospective analysis of 25 pediatric patients undergoing mitral valve repair for VSD-associated mitral regurgitation.
- Surgical techniques included annuloplasty, cleft suturing, and leaflet advancement.
- Preoperative mitral regurgitation severity ranged from 2+ to 4+.
Main Results:
- No early deaths; 92.0% actuarial survival rate at 15 years.
- Freedom from reoperation was 91.3% at 15 years.
- Postoperative moderate mitral regurgitation or stenosis occurred in 6/11 patients after bilateral annuloplasty; 19/22 survivors were NYHA class I.
Conclusions:
- Conservative mitral valve repair provides clinical improvement in most pediatric patients with VSD.
- Long-term monitoring is crucial for detecting mitral regurgitation and stenosis development, particularly after bilateral annuloplasty.
- Careful follow-up for growth potential is recommended post-repair.
Background:
We examined the results of intermediate and long-term follow-up of 25 patients aged 3 months to 11 years (mean, 2.6 +/- 2.3 years) who initially underwent conservative mitral valve repair for mitral regurgitation associated with ventricular septal defect between April 1973 and March 1991.
Methods:
The preoperative degree of mitral regurgitation was 2+ in 3, 3+ in 17, and 4+ in 5 patients, and the major causes of mitral regurgitation were annular dilatation and prolapse of the anterior leaflet. Annuloplasty was performed in all except 2 patients, suturing of the cleft was done in 3 patients, and posterior mitral leaflet advancement was done in 2 patients. In addition, the papillary muscle was incised and adhesive chordae were removed in 1 patient, and adhesive fused chordae were detached from a leaflet in 1 other patient.
Results:
There were no early deaths. Two patients with residual mitral regurgitation with or without mitral stenosis underwent reoperation for mitral valve replacement 2 months and 6 years after the mitral repair, respectively. Late death occurred in 2 patients, and the actuarial survival rate was 92.0% at 15 years after operation. The freedom from reoperation was 91.3% at both 10 and 15 years after the initial operation. Postoperative color Doppler flow imaging was performed in 22 of the 23 survivors, and results showed no mitral regurgitation in 4, mild regurgitation in 14, and moderate regurgitation in 4 patients. Four patients presently have mitral stenosis, with a mean transmitral pressure gradient greater than 10 mm Hg. The residual lesion of moderate mitral regurgitation with or without mitral stenosis developed in 6 of 11 patients in whom bilateral mitral annuloplasty was applied after the initial operation. Nineteen of the 22 survivors without reoperation were in New York Heart Association class I, and 3 were in class II.
Conclusions:
Clinical improvement was observed after conservative mitral repair in most pediatric patients with ventricular septal defect. However, careful follow-up for growth potential still appears to be needed to detect changes in mitral regurgitation and the development of mitral stenosis after valve repair, especially after bilateral annuloplasty.