title: Long-term results after mitral valve repair in children.
abstract: OBJECTIVE
  We analysed the long-term results of mitral valve (MV) repair in children.
  
  
  METHODS
  We reviewed clinical records of 139 children (<18 years) who underwent MV repair between 1988 and 2007. Patients with atrioventricular septal defect, single ventricle or atrioventricular discordance were excluded. Median age was 2.3 years (2 months to 17.6 years), and 47 children (34%) were infants. Mitral regurgitation (MR) was predominant in 125 patients (90%), and 91 (73%) of these showed MR grade > or = 3. Mitral stenosis (MS) was predominant in 14 patients (10%), and median mean pressure gradient across the MV was 9.0 mmHg (0-20 mmHg). Associated cardiac lesions were present in 111 patients (80%) and were addressed concurrently in 105 patients. Various surgical techniques were used according to the functional and pathologic findings of MV.
  
  
  RESULTS
  There was no early death. Median follow-up was 8 years (2 months to 20 years, 78% complete). Twenty-six patients required 29 MV re-operations, and 11 of these required MV replacements. At 15 years, freedom from MV re-operation and MV replacement was 77% and 90%, respectively. Diagnosis of MS and MV status on discharge (MR grade > or =3 or MS gradient > or =10 mmHg) were significant risk factors for re-operation. There were three late deaths, and the overall survival was 97% at 15 years. Among 122 survivors with MR, 102 patients (84%) underwent echocardiography during follow-up. The degree of MR decreased significantly and only five patients showed MR grade 3. Among 14 survivors with MS, eight patients (57%) underwent echocardiography during follow-up. The degree of MS decreased significantly and median MS gradient was 2.8 mmHg (0-10 mmHg). All survivors remain in the NYHA class I or II.
  
  
  CONCLUSIONS
  MV repair in children showed excellent survival, acceptable re-operation rate and satisfactory valve function at long-term follow-up. Residual MV dysfunction was a significant risk factor for re-operation, but re-repair was successful in more than half of the patients who underwent re-operation.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Sosa-gu, Bucheon, Kyungki-do 422-232, Republic of Korea. tscheul@hanmail.net
authors.forename: Cheul
authors.initials: C
authors.lastname: Lee
authors.forename: Chang-Ha
authors.initials: CH
authors.lastname: Lee
authors.forename: Jae Gun
authors.initials: JG
authors.lastname: Kwak
authors.forename: Chun Soo
authors.initials: CS
authors.lastname: Park
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Song
authors.forename: Woo-Sup
authors.initials: WS
authors.lastname: Shim
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome