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The development complex of " ' parachute mitral valve " , supravalvar ring of the left atrium , subaortic stenosis and coarctation of the aorta
AbstractOBJECTIVE: Mitral valve repair is now well established in adults.Congenital anomalies of the mitral valve, however, represent a more complexand diverse population with a high prevalence of associated cardiacanomalies. Less is known about the results of valve sparing surgery in thisgroup of patients. We reviewed our experience to determine these results.METHODS: Twenty three children with mitral valve anomalies and concordantatrioventricular and ventriculoarterial connections but excluding partialand total atrioventricular canal defect (AVC) or isolated cleft wereoperated on between January 1 1983 and January 1994. Mean age at operationwas 3.2 years (range 2 months- 10.7 years) with 10 patients less than 1year. Eighteen patients (78%) were in New York Heart Association Functionalclass (NYHA) 111/1V. Aetiology of mitral valve disease was congenital in 21(91.3) and ischaemic of congenital origin in 2 (8.7%). mitral regurgitationwas dominant in 13 (57%), mitral stenosis in 10 (43%)-5 parachute valves.Associated defects occurred in 15 patients (65.2%). All mitral incompetencepatients (13) had some form of annuloplasty-modified de Vega 5, Wooler Kay5, Paneth 2 and Puig Messana 1. RESULTS: Hospital mortality was 13% (3patients). Mean follow up time was 51.3 months with a cumulative follow upof 102.6 patient years There were 2 late deaths. Repeat operations wererequired in 3 patients-2 reparative and 1 mitral valve replacement. Onepatient awaits reoperation and the remaining 17 have no, minimal or mildmitral stenosis or incompetence on echocardiography. Seventeen (94%) of thesurviving patients are in NYHA 1/11. One and 7 year actuarial survivalrates are 82.2% +/- 7.9% and 77.4% +/- 8.7% while actuarial freedom fromreoperation was 95.5% +/- 4.3% at 1 year and 84.1% +/- 7.6% at 7 years.There has been no incidence of thromboembolism. CONCLUSIONS: Reparativetechniques can be successfully applied to congenital mitral valve disease,especially in children less than 1 year of age, and can be accomplishedwith a low hospital mortality and acceptable long term survival rates.
European Journal of Cardio-Thoracic Surgery – Oxford University Press
Published: Jul 1, 1996
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