10 YEARS EXPERIENCE OF AN AGGRESSIVE REPARATIVE APPROACH TO CONGENITAL MITRAL-VALVE ANOMALIES

Objective. Mitral valve repair is now well established in adults. Cong enital anomalies of the mitral valve, however, represent a more comple x and diverse population with a high prevalence of associated cardiac anomalies. Less is known about the results of valve sparing surgery in this group of patients. We reviewed our experience to determine these results. Methods. Twenty three children with mitral valve anomalies a nd concordant atrioventricular and ventriculoarterial connections but excluding partial and total atrioventricular canal defect (AVC) or iso lated cleft were operated on between January 1 1983 and January 1 1994 . Mean age at operation was 3.2 yeats (range 2 months - 10.7 years) wi th 10 patients less than 1 year. Eighteen patients (78%) were in New Y ork Heart Association Functional class (NYHA) 111/1V. Aetiology of mit ral valve disease was congenital in 21 (91.3) and ischaemic of congeni tal origin in 2 (8.7%). Mitral regurgitation was dominant in 13 (57%), mitral stenosis in 10 (43%) - 5 parachute valves. Associated defects occurred in 15 patients (65.2%). All mitral incompetence patients (13) had some form of annuloplasty - modified de Vega 5, Wooler Kay 5, Pan eth 2 and Puig Messana 1. Results. Hospital mortality was 13% (3 patie nts). Mean follow up time was 51.3 months with a cumulative follow up of 102.6 patient years There were 2 late deaths. Repeat operations wer e required in 3 patients 2 reparative and 1 mitral valve replacement. One patient awaits reoperation and the remaining 17 have no, minimal o r mild mitral stenosis or incompetence on echocardiography. Seventeen (94%) of the surviv ing patients are in NYHA 1/11. One and 7 year actu arial survival rates are 82.2%+/-7.9% and 77.4%+/-8.7% while actuarial freedom from reoperation was 95.5%+/-4.3% at 1 year and 84.1%+/-7.6% at 7 years. There has been no incidence of thromboembolism. Conclusion s. Reparative techniques can be successfully applied to congenital mit ral valve disease, especially in children less than 1 year of age, and can be accomplished with a low hospital mortality and acceptable long term survival rates.