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Korean J Thorac Cardiovasc Surg 2009; 42(3): 292-298

Published online June 5, 2009

Copyright © Journal of Chest Surgery.

Mitral Valve Repair for Congenital Mitral Regurgitation in Children

Kun-woo Kim, M.D.*, Chang-Hyu Choi, M.D.*, Kook-Yang Park, M.D.*, Mi-Jin Jung, M.D.*, Chul-Hyun Park, M.D.**, Yang-Bin Jeon, M.D.**, Jae-Ik Lee, M.D.*

Department of Thoracic and Cardiovascular Surgey, Gil Hospital, Gacheon University of Medicine and Science, Department of Cardiothoracic Surgery, Gachon University Gil Medical Center, Heart Center

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Surgery for mitral valve disease in children carries both technical and clinical difficulties that are due to both the wide spectrum of morphologic abnormalities and the high incidence of associated cardiac anomalies. The purpose of this study is to assess the outcome of mitral valve surgery for treating congenital mitral regurgitation in children. Material and Method: From 1997 to 2007, 22 children (mean age: 5.4 years) who had congenital mitral regurgitation underwent mitral valve repair. The median age of the patients was 5.4 years old and four patients (18%) were under 12 months of age. 15 patients (68%) had cardiac anomalies. There were 13 cases of ventricular septal defect, 1 case of atrial septal defect and 1 case of supravalvar aortic stenosis. The grade of the preoperative mitral valve regurgitation was II in 4 patients, III in 15 patients and IV in 3. The regurgitation was due to leaflet prolapse in 12 patients, annular dilatation in 4 patients and restrictive leaflet motion in 5 patients. The preoperative MV Z-value and the regurgitation grade were compared with those obtained at follow-up. Result: MV repair was possible in all the patients. 19 patients required reduction annuloplasty and 18 patients required valvuloplasty that included shortening of the chordae, papillary muscle splitting, artificial chordae insertion and cleft closure. There were no early or late deaths. The mitral valve regurgitation after surgery was improved in all patients (absent=10, grade I=5, II=5, III=2). MV repair resulted in reduction of the mitral valve Z-value (2.2±2.1 vs. 0.7±2.3, respectively, p<0.01). During the mid-term follow-up period of 3.68 years, reoperation was done in three patients (one with repair and two with replacement) and three patients showed mild progression of their mitral regurgitation. Conclusion: Our experience indicates that mitral valve repair in children with congenital mitral valve regurgitation is an effective and reliable surgical method with a low reoperation rate. A good postoperative outcome can be obtained by preoperatively recognizing the intrinsic mitral valve pathophysiology detected on echocardiography and with the well-designed, aggressive application of the various reconstruction techniques. (Korean J Thorac Cardiovasc Surg 2009;42:292-298)

Keywords: 1. Child, 2. Mitral valve, 3. Mitral valve insufficiency, 4. Mitral valve, repair

Article

Original Article

Korean J Thorac Cardiovasc Surg 2009; 42(3): 292-298

Published online June 5, 2009

Copyright © Journal of Chest Surgery.

Mitral Valve Repair for Congenital Mitral Regurgitation in Children

Kun-woo Kim, M.D.*, Chang-Hyu Choi, M.D.*, Kook-Yang Park, M.D.*, Mi-Jin Jung, M.D.*, Chul-Hyun Park, M.D.**, Yang-Bin Jeon, M.D.**, Jae-Ik Lee, M.D.*

Department of Thoracic and Cardiovascular Surgey, Gil Hospital, Gacheon University of Medicine and Science, Department of Cardiothoracic Surgery, Gachon University Gil Medical Center, Heart Center

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Surgery for mitral valve disease in children carries both technical and clinical difficulties that are due to both the wide spectrum of morphologic abnormalities and the high incidence of associated cardiac anomalies. The purpose of this study is to assess the outcome of mitral valve surgery for treating congenital mitral regurgitation in children. Material and Method: From 1997 to 2007, 22 children (mean age: 5.4 years) who had congenital mitral regurgitation underwent mitral valve repair. The median age of the patients was 5.4 years old and four patients (18%) were under 12 months of age. 15 patients (68%) had cardiac anomalies. There were 13 cases of ventricular septal defect, 1 case of atrial septal defect and 1 case of supravalvar aortic stenosis. The grade of the preoperative mitral valve regurgitation was II in 4 patients, III in 15 patients and IV in 3. The regurgitation was due to leaflet prolapse in 12 patients, annular dilatation in 4 patients and restrictive leaflet motion in 5 patients. The preoperative MV Z-value and the regurgitation grade were compared with those obtained at follow-up. Result: MV repair was possible in all the patients. 19 patients required reduction annuloplasty and 18 patients required valvuloplasty that included shortening of the chordae, papillary muscle splitting, artificial chordae insertion and cleft closure. There were no early or late deaths. The mitral valve regurgitation after surgery was improved in all patients (absent=10, grade I=5, II=5, III=2). MV repair resulted in reduction of the mitral valve Z-value (2.2±2.1 vs. 0.7±2.3, respectively, p<0.01). During the mid-term follow-up period of 3.68 years, reoperation was done in three patients (one with repair and two with replacement) and three patients showed mild progression of their mitral regurgitation. Conclusion: Our experience indicates that mitral valve repair in children with congenital mitral valve regurgitation is an effective and reliable surgical method with a low reoperation rate. A good postoperative outcome can be obtained by preoperatively recognizing the intrinsic mitral valve pathophysiology detected on echocardiography and with the well-designed, aggressive application of the various reconstruction techniques. (Korean J Thorac Cardiovasc Surg 2009;42:292-298)

Keywords: 1. Child, 2. Mitral valve, 3. Mitral valve insufficiency, 4. Mitral valve, repair

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