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Mid- to Long-term Outcome of Mitral Valve Repair for Congenital Mitral Regurgitation in Infants Less than 7 Years Old

Pediatric Cardiology and Cardiac Surgery
Vol.25 No.6 2009 (808-813)

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Yu Oshima,1, 3) Shingo Kasahara,1) Ko Yoshizumi,1,4) Teiji Akagi,1) Naoki Ohno,2) Yoshio Okamoto,2) Shinichi Ohtsuki,2) and Shunji Sano1)

Departments of 1)Cardiovascular Surgery, 2)Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, 3)Department of Cardiovascular Surgery, Shin-Tokyo Hospital, Matsudo, and 4)Department of General and Cardiothoracic Surgery, Kanazawa University Hospital, Kanazawa, Japan

Abstract

Background: Previous reports have addressed the superiority of mitral valve repair (MVP) over mitral valve replacement (MVR) in children, especially in infants with mitral valve regurgitation (MR). However, little information is available about mid- to long-term results of this group of patients undergoing MVP.
Methods: Between December 1991 and January 2008, 27 patients with congenital MR younger than 7 years old underwent 28 MVPs including one redo MVP. Preoperative grades of MR on two-dimensional echocardiogram (2DE) were severe in 18, moderate in 8, and mild in 2. The median age was 10 months (3 months to 6 years). Patients with MR associated with atrioventricular septal defect, Marfan’s syndrome, and single ventricle morphology were excluded from this study. According to the Carpentier classification, 5 patients had type 1 MR, 16 had type 2, and 7 type 3. Kay/Reed’s annuloplasty without prosthetic materials was applied in 25 cases. Two had artificial chord reconstruction using ePTFE suture. Alfieri’s double-orifice repair was performed in 2. Two with dysplastic leaflet had cusp extension with autologous pericardial patch.
Results: There were no early or late deaths. The mean follow-up period was 7 years (1 month to 13 years). One redo occurred in a patient having had initial MVP 2 years before. No MVR was necessary. Postoperative latest MR grades on 2DE were moderate in 4, mild or less in 24. Actuarial freedom from reoperation was 95% (95% confidence interval: 85–104%) at 10 years.
Conclusion: Mid- to long-term results of infants and small children with congenital MR were acceptable, even if some patients had residual MR. Freedom from MVR was 100% utilizing various repair techniques.