title: Surgical repair of the congenitally malformed mitral valve in infants and children.
abstract: BACKGROUND
  Mitral valve remodeling techniques were applied to 26 infants and children (mean age, 6.0 years, range, 0.4 to 15.9 years) with various forms of congenital mitral valve disease over a 7-year period. Patients with atrioventricular canal, L-transposition and single ventricle were excluded. Intraoperative transesophageal echocardiography (TEE) was utilized to assess the repair and guide the need for immediate intervention.
  
  
  METHODS
  Twenty-one patients had mitral regurgitation: 10 with cleft anterior mitral leaflet, 7 with annular dilatation, 1 with normal leaflets with an obstructing cord, 2 with prolapsed leaflets and elongated cords, and 1 with restricted leaflet motion, normal papillary muscles, and shortened cords. Of the 5 mitral stenosis patients, 3 had supravalvular mitral ring, 1 had midvalvular mitral ring, and 1 had a parachute valve. Three of the mitral stenosis patients had additional stenotic lesions. Concurrent repair of associated lesions was performed in 21 patients (78%).
  
  
  RESULTS
  Operative mortality was 3.8% (n = 1). There were no late deaths. Immediate rerepair in 4 patients resulted in improved function. All mitral stenosis patients improved. A total of 20 mitral regurgitation patients (95%) improved; 1 required mitral valve replacement. Mean follow-up is 31 months (range, 2 to 81 months). All patients are in New York Heart Association functional class I or II.
  
  
  CONCLUSIONS
  Mitral valve repair can be successfully performed in infants and children with excellent short- and midterm results. Assessment using transesophageal echocardiography can guide the necessity for immediate rerepair to achieve improved function.
authors.affiliation: The Children's Memorial Hospital, and Department of Surgery, Northwestern University Medical School, Chicago, Illinois 60614, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Zias
authors.forename: C
authors.initials: C
authors.lastname: Mavroudis
authors.forename: C L
authors.initials: CL
authors.lastname: Backer
authors.forename: L M
authors.initials: LM
authors.lastname: Kohr
authors.forename: N L
authors.initials: NL
authors.lastname: Gotteiner
authors.forename: A P
authors.initials: AP
authors.lastname: Rocchini
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008722:Methods; D008943:Mitral Valve / Q000002:abnormalities* / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000151:congenital / Q000401:mortality / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000151:congenital / Q000401:mortality / Q000601:surgery