title: Repair of congenital malformations of the mitral valve: early and midterm results.
abstract: BACKGROUND
  The aims of this study were to determine early and midterm survival and freedom from reoperation, and to identify the predictors for poor postoperative outcome in children undergoing mitral valve (MV) repair owing to congenital malformations of the mitral valve.
  
  
  METHODS
  Between January 1990 and February 2001, 94 consecutive children with congenital MV disease underwent valve repair. The mean age was 5.2+/-3.3 years (range 20 days to 15 years). Twenty-five (26.6%) children were less than 1 year old. Isolated MV disease was found in 21 (22.4%) patients. MV stenosis was the predominant lesion in 21 (22.4%) patients with a mean left atrial to left ventricle diastolic peak gradient of 24.5+/-9.2 mm Hg. MV regurgitation was the predominant pathophysiology in 73 (77.6%) patients with a mean regurgitation grade of 3.3+/-0.7.
  
  
  RESULTS
  The hospital mortality was 8.5% (8 of 94). Three patients required permanent pacemaker implantation owing to complete atrioventricular block. Two patients underwent mediastinal exploration for significant bleeding. Postoperatively the echocardiography color Doppler study demonstrated a significantly lower mean end diastolic left atrium to left ventricle gradient 8.7+/-2.2 mm Hg (p < 0.001) in patients with MV stenosis and a mean regurgitation grade of 0.9+/-0.6 (p < 0.001) in patients with MV regurgitation. Actuarial survival and actuarial reoperation-free survival were 89.2% and 76.3%, respectively. Multivariate analysis demonstrated that age less than 1 year (p = 0.035), hammock MV (p = 0.0093), cardiothoracic ratio greater than 0.6 (p < 0.0001), and associated cardiac anomalies (p = 0.003) were strong predictors for poor overall freedom from reoperation and midterm survival.
  
  
  CONCLUSIONS
  Mitral valve repair for congenital mitral valve disease yields acceptable early and midterm mortality and reoperation rates. Strong predictors for poor overall freedom from reoperation and midterm survival were age less than 1 year, hammock MV, cardiothoracic ratio greater than 0.6, and associated cardiac anomalies.
authors.affiliation: G. Pasquinucci Hospital, CREAS-IFC-CNR, Massa, Italy. edvinprifti@hotmail.com
authors.forename: Edvin
authors.initials: E
authors.lastname: Prifti
authors.forename: Vittorio
authors.initials: V
authors.lastname: Vanini
authors.forename: Massimo
authors.initials: M
authors.lastname: Bonacchi
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.forename: Massimo
authors.initials: M
authors.lastname: Bernabei
authors.forename: Gabriele
authors.initials: G
authors.lastname: Giunti
authors.forename: Adrian
authors.initials: A
authors.lastname: Crucean
authors.forename: Stefano Vincenzo
authors.initials: SV
authors.lastname: Luisi
authors.forename: Bruno
authors.initials: B
authors.lastname: Murzi
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008943:Mitral Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000151:congenital / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000151:congenital / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D015996:Survival Rate