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J Thorac Cardiovasc Surg 2008;135:1313-1321
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Surgical treatment of congenital mitral valve disease: Midterm results of a repair-oriented policy

^a Cardiac Surgical Unit, Royal Children's Hospital, Melbourne, Australia
^b Australia and New Zealand Children's Heart Research Centre, Royal Children's Hospital, Melbourne, Australia
^c Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
^d Department of Paediatrics, University of Melbourne, Melbourne, Australia

Received for publication May 16, 2007; revisions received August 13, 2007; accepted for publication September 25, 2007.

^_* Address for reprints: Christian P. Brizard, MD, Cardiac Surgical Unit, Royal Children's Hospital, Flemington Rd, Melbourne, VIC 3052, Australia. (Email: christian.brizard{at}rch.org.au).

Objective: Management of congenital mitral valve disease is challenging because of a wide morphologic spectrum, frequent associated lesions, and small patient size. We evaluated the results of a repair-oriented policy.

Methods: All consecutive patients with congenital mitral valve disease who underwent surgery between 1996 and 2006 were studied retrospectively. Patients with atrioventricular canal, atrioventricular discordance, or ischemic regurgitation were excluded.

Results: During this period, 71 children (median age 2.9 years, range 3 days–20.8 years) underwent surgery. All but 1 underwent primary mitral valve repair. Twenty-two (30%) were younger than 12 months. Associated cardiac lesions were present in 45 children (63%) and were addressed concurrently in 35; previous cardiac procedures had been performed in 17 patients (24%). Mitral incompetence was predominant in 60 (85%) and stenosis in 11 (15%). During a median follow-up of 47.8 months (range 2–120 months), 14 patients underwent 17 mitral reinterventions: 14 repairs and 3 replacements. After 60 months, overall survival was 94% ± 2.8%; freedoms from reoperation and prosthesis implantation were 76% ± 5.6% and 94% ± 3.6%, respectively. There were 4 deaths, and all survivors remain in New York Heart Association class I or II with moderate (6 patients) or less mitral dysfunction.

Conclusion: Surgical repair of the congenital mitral valve can be successfully performed with low mortality, satisfactory valvular function at midterm follow-up, and acceptable reoperation rate while obviating risks associated with valvular prostheses. Suboptimal primary repair was significant predictor for reoperation but re-repair was often successful.

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Discussion
J. Thorac. Cardiovasc. Surg. 2008 135: 1320-1321. [Extract] [Full Text] [PDF]