title: Supra-annular mitral valve implantation in very small children.
abstract: OBJECTIVE
  Mitral valve replacement (MVR) is a surgical option when mitral valvuloplasty is not feasible/successful. This study reviews our experience with MVR in very young children.
  
  
  METHODS
  From July 2004 to January 2014, seven children (mean age 13.3 ± 11.2 months; range 4 months to 35 months; mean body weight 6.0 ± 2.2 kg) underwent MVR with a mechanical prosthesis in the supra-annular position. To provide better exposure in the left atrium, we performed in all but one case a biatrial transeptal incision according to Guiraudon. Six patients had congenital defects of the mitral valve and one had rheumatic. Six patients had undergone previous cardiosurgical procedures.
  
  
  RESULTS
  All patients were implanted with a CarboMedics (CarboMedics, Austin, TX, USA) mechanical prosthesis. Mean prosthesis size was 19.0 ± 3.1 mm (range 16 to 25). There were no cases of operative or late mortality. At follow-up (mean 67.1 ± 34.8 months; range 25 to 108 months) two patients (28.6%) required reoperation both for thrombotic pannus formation over the disc at two and three months from first operation, respectively; only in one case was replacement necessary.
  
  
  CONCLUSIONS
  Supra-annular MVR may be considered a feasible secondary surgical option in children with a small annulus when mitral valvuloplasty is unsuccessful or unsuitable. Early and mid-term outcomes are acceptable but complications are not uncommon, especially related to thrombotic events.
authors.affiliation: Pediatric Cardiac Surgery, The Heart Hospital, Tuscany Foundation "Gabriele Monasterio", Massa, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Giordano
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Cantinotti
authors.forename: Vitali
authors.initials: V
authors.lastname: Pak
authors.forename: Luigi
authors.initials: L
authors.lastname: Arcieri
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Poli
authors.forename: Nadia
authors.initials: N
authors.lastname: Assanta
authors.forename: Riccardo
authors.initials: R
authors.lastname: Moschetti
authors.forename: Bruno
authors.initials: B
authors.lastname: Murzi
mesh_terms: D000367:Age Factors; D001835:Body Weight; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D008943:Mitral Valve / Q000002:abnormalities / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013927:Thrombosis; D016896:Treatment Outcome