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Long-term results after mitral valve repair in children

^a Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, 91-121 Sosa Bon 2-dong, Sosa-gu, Bucheon, Kyungki-do 422-232, Republic of Korea
^b Department of Pediatric Cardiology, Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea

Received 1 May 2009; received in revised form 13 July 2009; accepted 31 July 2009.

^_* Corresponding author. Tel.: +82 32 340 1751; fax: +82 32 340 1236. (Email: tscheul{at}hanmail.net).

Objective: We analysed the long-term results of mitral valve (MV) repair in children. Methods: We reviewed clinical records of 139 children (<18 years) who underwent MV repair between 1988 and 2007. Patients with atrioventricular septal defect, single ventricle or atrioventricular discordance were excluded. Median age was 2.3 years (2 months to 17.6 years), and 47 children (34%) were infants. Mitral regurgitation (MR) was predominant in 125 patients (90%), and 91 (73%) of these showed MR grade 3. Mitral stenosis (MS) was predominant in 14 patients (10%), and median mean pressure gradient across the MV was 9.0 mmHg (0–20 mmHg). Associated cardiac lesions were present in 111 patients (80%) and were addressed concurrently in 105 patients. Various surgical techniques were used according to the functional and pathologic findings of MV. Results: There was no early death. Median follow-up was 8 years (2 months to 20 years, 78% complete). Twenty-six patients required 29 MV re-operations, and 11 of these required MV replacements. At 15 years, freedom from MV re-operation and MV replacement was 77% and 90%, respectively. Diagnosis of MS and MV status on discharge (MR grade 3 or MS gradient 10 mmHg) were significant risk factors for re-operation. There were three late deaths, and the overall survival was 97% at 15 years. Among 122 survivors with MR, 102 patients (84%) underwent echocardiography during follow-up. The degree of MR decreased significantly and only five patients showed MR grade 3. Among 14 survivors with MS, eight patients (57%) underwent echocardiography during follow-up. The degree of MS decreased significantly and median MS gradient was 2.8 mmHg (0–10 mmHg). All survivors remain in the NYHA class I or II. Conclusions: MV repair in children showed excellent survival, acceptable re-operation rate and satisfactory valve function at long-term follow-up. Residual MV dysfunction was a significant risk factor for re-operation, but re-repair was successful in more than half of the patients who underwent re-operation.

Key Words: Mitral regurgitation • Mitral stenosis • Congenital heart defect