Surgery for mitral valve disease in the pediatric age group

Objectives: We reviewed a 20-year experience with the surgical treatment of mitral valve disease in the pediatric age group at our institution with 2 objectives: to clarify the long-term results over the last 2 decades and to evaluate the recent advances in mitral valve operation in children. Method s: Since December 1978, 56 patients have undergone a total of 36 mitral val ve repairs and 30 mitral valve replacements. Associated cardiac anomalies w ere present in 46 patients (82%), and concurrent repair of associated lesio ns was performed in 37 patients (66%), The age of the patients ranged from 3 months to 15 years (mean, 3.6 years) at mitral valve repair, and ranged f rom 2 months to 16 years (mean, 5.7 years) at mitral valve replacement. Mea n follow-up period was 92.0 months (range, 1-235 months). Results: There we re 2 hospital deaths and 2 late deaths in patients who underwent mitral val ve repair. Reoperation was performed in 4 patients. Three of these patients underwent mitral valve replacement because of residual mitral incompetence . No hospital deaths occurred in patients who underwent mitral valve replac ement. Two late deaths occurred after mitral valve replacement. Six patient s had a total of 10 episodes of prosthetic valve thrombosis. Thrombolytic t herapy with urokinase was successful in all episodes without serious compli cations. Five patients required reoperations 49 to 141 months (mean, 78.4 m onths) after the initial valve replacement for relative prosthetic valve ob struction as the result of somatic growth. A valve 2 or 3 sizes larger than the original prostheses was inserted without death. Actuarial survival and freedom from cardiac events at 10 years after the operation were 87.2% and 72.7% in children who underwent mitral valve repair, and 90.3% and 67.3% f or those children who underwent mitral valve replacement. Conclusions: The current risk of mitral valve operation in the pediatric age group is low an d the long-term results are satisfactory, irrespective of severe deformatio n of the mitral valve apparatus and associated complex cardiac anomalies.