Mitral valve repair for congenital mitral valve stenosis in the pediatric population.
BACKGROUND
Mitral valve repair is the preferred approach for congenital mitral valve stenosis in children. However, repairs in this population remain challenging.


METHODS
From 2001 to 2009, mitral valve repair was attempted in 20 consecutive congenital mitral valve stenosis patients. The median age and body weight at operation were 1.4 +/- 1.9 years and 7.4 +/- 4.1 kg, respectively. Multiple level left-side heart obstruction was present in 14 patients (70%). Moderate or more mitral insufficiency was present in 5 patients.


RESULTS
The main etiology of the stenosis was valvular in 5 patients, supravalvular mitral ring in 4, single or predominant papillary muscle in 9, and hammock mitral valve in 2. Freedom from hospital death or transplantation was 85% (17 of 20). Two patients required replacement before discharge. In the 15 successfully repaired patients, mean mitral valve inflow pressure gradient improved from 13.9 +/- 2.7 mm Hg to 5.5 +/- 1.6 mm Hg (p < 0.0001). There were no late deaths at a mean follow-up of 46 +/- 31 months (range, 6.3 to 98.5). One patient required a second repair, and no patient has required replacement. At the last follow-up, mean mitral valve inflow pressure gradient was 7.5 +/- 4.1 mm Hg, and moderate or more mitral insufficiency was detected in 2 patients.


CONCLUSIONS
Mitral valve repair for congenital mitral valve stenosis can be performed in this challenging population of patients with good early survival and freedom from transplantation. Conditional follow-up for successfully repaired patients demonstrates preserved mitral valve function without need for replacement.
Hoashi
Takaya
T
Division of Pediatric Cardiovascular Surgery, Section of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan 48109-5864, USA. thoashi@surg1.med.osaka-u.ac.jp.
Bove
Edward L
EL
Devaney
Eric J
EJ
Hirsch
Jennifer C
JC
Ohye
Richard G
RG
D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008943:Mitral Valve / Q000033:anatomy & histology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome