European Journal of Cardio-Thoracic Surgery, Vol 10, 534-539, Copyright © 1996 by European Association for Cardio-thoracic Surgery
Ten years' experience of an aggressive reparative approach to congenital mitral valve anomalies
JF McCarthy, MC Neligan and AE Wood
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, USA.
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.
