Surgical repair of the mitral valve in children with dilated cardiomyopathy and mitral regurgitation.
BACKGROUND
Significant mitral regurgitation is known to exacerbate left ventricular dysfunction in dilated cardiomyopathy. Although intervention on the regurgitant mitral valve is frequently described in adults, there is little pediatric data.


METHODS
Five children (aged 3 months to 4 years) with dilated cardiomyopathy and mitral regurgitation underwent mitral valve repair between January 1999 and January 2007 at our institution. All had mitral regurgitation graded as moderate to severe, with ejection fractions of 35% to 60% (median 53%).


RESULTS
There were no deaths; all children were weaned from cardiopulmonary bypass; 1 child required cardiac transplantation 3 weeks after repair. After surgery, mitral regurgitation was moderate in 1 patient, mild in 2 patients, and trivial in 2 patients. The 4 successful cases showed an improvement in functional status at latest follow-up (range, 8 years to 4 months): all were asymptomatic (4 children had preoperative symptoms). Successful cases showed a decreased left atrial dimension (mean z-score 3.8 to 2.6) and a decreased left ventricular end-diastolic diameter (mean 6.9 +/- 1.6 to 5.4 +/- 1.2). Ejection fraction and left ventricular end-systolic index did not show an improvement and declined in some cases.


CONCLUSIONS
We conclude that repair of the mitral valve is feasible in children with dilated cardiomyopathy and acquired mitral regurgitation. Most of the children demonstrated decreased left ventricular chamber sizes and an improved functional status. Although this operation improves symptoms, it is not clear whether it postpones or abrogates the need for cardiac transplantation.
Walsh
Mark A
MA
Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada. mark.walsh@sickkids.ca
Benson
Lee N
LN
Dipchand
Anne I
AI
Redington
Andrew N
AN
Caldarone
Christopher A
CA
Van Arsdell
Glen S
GS
Kantor
Paul F
PF
D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007223:Infant; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000601:surgery; D016277:Ventricular Function, Left / Q000502:physiology