EARLY AND LATE RESULTS OF MITRAL-VALVE REPAIR IN CHILDREN

Mitral valve repair in children has the advantage of avoiding mitral v alve replacement with its attendant need for anticoagulation and reope ration. Seventy-nine children between the ages of 2 months and 17 year s (mean 4.9 years) underwent mitral valve repair between May 1982 and April 1993. There were five patients with mitral stenosis and 74 patie nts with mitral regurgitation, and 19 children were less than 2 years of age. Patients were divided into anatomic subgroups on the basis of the primary cardiac pathologic condition. Forty-three had severe mitra l regurgitation, 21 had moderate mitral regurgitation, and 12 patients with primum atrial-septal defect and 2 patients with univentricular h earts had minimal to moderate mitral regurgitation. Associated cardiac anomalies were present in 68 patients and 85% of the patients require d concomitant intracardiac procedures. The methods of mitral valve rep air included annuloplasty in 68 (86%), repair of cleft leaflet in 41 ( 52%), chordal shortening in 9 (11%), triangular leaflet resection in 8 (10%), splitting of papillary muscles with resection of subvalvular a pparatus in 7 (9%), and chordal substitution in 1 (1%). The technique of annuloplasty was modified to allow for annular growth. Follow-up wa s available from 1 to 10 years (mean 4 +/- 2.5 years). There were thre e early deaths (4%), all occurring as a result of low output cardiac f ailure in patients with minimal postoperative mitral regurgitation. Th ree late deaths (4%) occurred in patients with persistent moderate to severe mitral regurgitation and progressive cardiac failure and eight patients (10%) required either rerepair or replacement of the mitral v alve. Actuarial survival was 94% at 1 year, 84% at 2 years, and 82% at 5 years, and actuarial freedom from reoperation was 89% at 8 years. A h patients received postoperative echocardiography with 82% having min imal to no mitral regurgitation and 98% of long-term surviving patient s being free of symptoms. We conclude that mitral valve repair can be done with low early and late mortality. The need for reoperation is re latively low and valve growth has occurred with the use of a modified annuloplasty.