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Late left ventricular function after surgery for children with chronic symptomatic mitral regurgitation
U S Krishnan1, W M Gersony, E Berman-Rosenzweig
1Columbia University College of Physicians and Surgeons and the Department of Pediatrics, Babies and Children's Hospital, New York, NY 10032, USA.
Circulation
|January 7, 1998
Summary
Pediatric mitral regurgitation surgery normalizes left ventricular function long-term. Delaying surgery in children until severe symptoms appear does not increase the risk of ventricular dysfunction, but may increase atrial arrhythmias.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Quantitative echocardiography aids surgical timing in adult mitral regurgitation.
- Pediatric mitral regurgitation surgery is often delayed due to patient size and anticoagulation needs.
- Delayed surgery in children may lead to severe symptoms and potential reoperation.
Purpose of the Study:
- To assess long-term ventricular function after mitral valve surgery in children.
- To identify risk factors for adverse outcomes in pediatric mitral regurgitation surgery.
Main Methods:
- Studied 33 pediatric patients (0.5-19 years) with mitral regurgitation.
- Assessed left ventricular shortening fraction preoperatively and postoperatively.
- Followed patients for a mean of 4.5 years after mitral valvuloplasty or replacement.
Main Results:
- Early postoperative ventricular function was reduced but improved significantly on late follow-up.
- Late left ventricular function normalized in most patients, with only one showing dysfunction.
- Preoperative function did not correlate with early or late postoperative values.
- Duration of mitral insufficiency was associated with atrial arrhythmias.
Conclusions:
- Late left ventricular function normalizes after surgical correction of mitral insufficiency in children.
- Delayed surgery in children with significant mitral regurgitation does not increase the risk of long-term ventricular dysfunction.
- Late atrial arrhythmias are more common in children who undergo delayed surgery.