J F McCarthy1, M C Neligan, A E Wood. 1. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, USA.
Abstract
OBJECTIVE: Mitral valve repair is now well established in adults. Congenital anomalies of the mitral valve, however, represent a more complex and diverse population with a high prevalence of associated cardiac anomalies. Less is known about the results of valve sparing surgery in this group of patients. We reviewed our experience to determine these results. METHODS: Twenty three children with mitral valve anomalies and concordant atrioventricular and ventriculoarterial connections but excluding partial and total atrioventricular canal defect (AVC) or isolated cleft were operated on between January 1 1983 and January 1994. Mean age at operation was 3.2 years (range 2 months-10.7 years) with 10 patients less than 1 year. Eighteen patients (78%) were in New York Heart Association Functional class (NYHA) 111/1V. Aetiology of mitral valve disease was congenital in 21 (91.3) and ischaemic of congenital origin in 2 (8.7%). mitral regurgitation was dominant in 13 (57%), mitral stenosis in 10 (43%)-5 parachute valves. Associated defects occurred in 15 patients (65.2%). All mitral incompetence patients (13) had some form of annuloplasty-modified de Vega 5, Wooler Kay 5, Paneth 2 and Puig Messana 1. RESULTS: Hospital mortality was 13% (3 patients). Mean follow up time was 51.3 months with a cumulative follow up of 102.6 patient years There were 2 late deaths. Repeat operations were required in 3 patients-2 reparative and 1 mitral valve replacement. One patient awaits reoperation and the remaining 17 have no, minimal or mild mitral stenosis or incompetence on echocardiography. Seventeen (94%) of the surviving patients are in NYHA 1/11. One and 7 year actuarial survival rates are 82.2% +/- 7.9% and 77.4% +/- 8.7% while actuarial freedom from reoperation was 95.5% +/- 4.3% at 1 year and 84.1% +/- 7.6% at 7 years. There has been no incidence of thromboembolism. CONCLUSIONS: Reparative techniques can be successfully applied to congenital mitral valve disease, especially in children less than 1 year of age, and can be accomplished with a low hospital mortality and acceptable long term survival rates.
OBJECTIVE:Mitral valve repair is now well established in adults. Congenital anomalies of the mitral valve, however, represent a more complex and diverse population with a high prevalence of associated cardiac anomalies. Less is known about the results of valve sparing surgery in this group of patients. We reviewed our experience to determine these results. METHODS: Twenty three children with mitral valve anomalies and concordant atrioventricular and ventriculoarterial connections but excluding partial and total atrioventricular canal defect (AVC) or isolated cleft were operated on between January 1 1983 and January 1994. Mean age at operation was 3.2 years (range 2 months-10.7 years) with 10 patients less than 1 year. Eighteen patients (78%) were in New York Heart Association Functional class (NYHA) 111/1V. Aetiology of mitral valve disease was congenital in 21 (91.3) and ischaemic of congenital origin in 2 (8.7%). mitral regurgitation was dominant in 13 (57%), mitral stenosis in 10 (43%)-5 parachute valves. Associated defects occurred in 15 patients (65.2%). All mitral incompetencepatients (13) had some form of annuloplasty-modified de Vega 5, Wooler Kay 5, Paneth 2 and Puig Messana 1. RESULTS: Hospital mortality was 13% (3 patients). Mean follow up time was 51.3 months with a cumulative follow up of 102.6 patient years There were 2 late deaths. Repeat operations were required in 3 patients-2 reparative and 1 mitral valve replacement. One patient awaits reoperation and the remaining 17 have no, minimal or mild mitral stenosis or incompetence on echocardiography. Seventeen (94%) of the surviving patients are in NYHA 1/11. One and 7 year actuarial survival rates are 82.2% +/- 7.9% and 77.4% +/- 8.7% while actuarial freedom from reoperation was 95.5% +/- 4.3% at 1 year and 84.1% +/- 7.6% at 7 years. There has been no incidence of thromboembolism. CONCLUSIONS: Reparative techniques can be successfully applied to congenital mitral valve disease, especially in children less than 1 year of age, and can be accomplished with a low hospital mortality and acceptable long term survival rates.