Early and late results of partial plication annuloplasty for congenital mitral insufficiency

Background: Partial plication annuloplasty is the main technique for congen ital mitral insufficiency because this technique allows the mitral anulus t o grow, in contrast to ring annuloplasty. However, this technique is not sa tisfactory for mitral insufficiency with some anomalies of the mitral valve apparatus. Methods: Forty-one patients underwent partial plication annuloplasty for mi tral regurgitation from July 1979 to December 1998. Mitral regurgitation as sociated with an atrioventricular defect, an atrioventricular discordance, and a univentricular heart was excluded from this study. Results: There were no early or late deaths. In early results, partial plic ation annuloplasty was more effective for mitral regurgitation with abnorma lity of the posterior leaflet (n = 14) or normal leaflet motion (n = 8) tha n with abnormality of the anterior leaflet and its apparatus (n = 14) or ab sence of chordae (n = 4). The mean follow-up period was 145.8 months. Durin g the follow-up period, 2 patients underwent mitral valve replacement, and a third patient underwent mitral valve repair with partial plication annulo plasty after the first repair. The main cause of mitral regurgitation of 2 of the 3 patients was absence of chordae. The actuarial freedom from reoper ation rate was 94.9% +/- 3.6%, 91.9% +/- 4.7%, and 91.9% +/- 4.7% at 5, 10, and 15 years after the operation, respectively. Conclusion: Early and long-term results of partial plication annuloplasty w ere acceptable for congenital mitral insufficiency with any type of malform ation of the mitral valve, and results were excellent with abnormality of t he posterior leaflet and its apparatus or normal leaflet motion. However, l ate results were suboptimal for mitral regurgitation with absence of chorda e. Other techniques, such as artificial chorda replacement, should be adapt ed in these cases.