Valve repair in children with congenital mitral lesions: Late clinical results

Mitral valve repair may be performed without ring support with advantages r elated to results and complications. The objective of this study was to ana lyze the long-term clinical results following surgical repair and reconstru ction without the use of rings in cases of congenital mitral lesions in chi ldren less than 12 years of age. Twenty-one patients who had undergone surg ery during the period from 1975 to 1998 were evaluated. The mean age was 4. 6 +/- 3.4 years. Females represented 47.6% of the total. Mitral regurgitati on was present in 57.1% (12 patients), stenosis in 28.6% (6 patients), and the mixed lesion group represented 14.3% (3 patients). Perfusion time was 4 3.1 +/- 9.5 minutes and ischemic time 29.4 +/- 10.5 minutes. Follow-up time was 41.5 +/- 53.6 months for the regurgitation group, 46.3 +/- 32.0 months for the stenosis group, and 39.41 +/- 37.51 months for the mixed lesion gr oup. Echocardiographical follow-up time was 37.17 +/- 39.51 months for the regurgitation group, 42.61 +/- 30.59 months for the stenosis group, and 39. 41 +/- 37.51 months for the mixed lesion group. Operative mortality was 9.5 % (two cases). There were no late deaths. In the regurgitation group, 10 pa tients (83.3%) were asymptomatic (p = 0.004). In the echocardiographical fo llow-up, most of the patients had minimal regurgitation. In the clinical fo llow-up of the stenosis group all patients were in functional class I (NYHA ). The mean transvalvular gradient measured by echocardiography was from 8 to 12 mmHg with a mean gradient of 10.7 mmHg. In the mixed lesion group the re was one reoperation at postoperative month 43. There were no cases of en docarditis or thromboembolism. Mitral valve repair in congenital lesions is associated with good late results. The majority of cases in the regurgitat ion group remain asymptomatic and do not require reoperation. Rings or annu lar support are not necessary in such cases. Satisfactory repair is more di fficult to achieve in cases of mitral stenosis due to valvular abnormalitie s and the seriousness of the associated lesions.