SURGICAL-TREATMENT OF CONGENITAL MITRAL VALVAR INSUFFICIENCY - THE HOPITAL-BROUSSAIS EXPERIENCE

There are many congenital malformations of the mitral valve which prod uce valvar insufficiency. From a surgical point of view, systems based exclusively on anatomic analysis are not always entirely appropriate for assessment of these lesions. With this in mind, Carpentier propose d a functional approach for analysis based upon the motion of the valv ar leaflets. From 1969 to 1994, 135 children under the age of 12 (mean age: 5.8 + 3.15 Y,0.6-12Y) underwent surgery in our department, basin g treatment on such analysis. Since motion of the leaflets during the operation is compromised by cardioplegia, and sometimes exposure can b e however difficult, preoperative echocardiography was a mandatory par t of the diagnostic cascade. Normal motion of the leaflets was present in 41 patients, with deformation of the annulus in 14, a cleft in 21, and partial agenesis in 6. Prolapse of leaflets was present in 42 pat ients. Leaflet motion was restricted in 28 patients. These were divide d in two groups, one with normal papillary muscles and commissural fus ion(7) or short cords.(6) The other with abnormal papillary muscles pr oducing a parachute arrangement in 6 and a hammock valve in 9. Associa ted lesions were present in 47% of the patients. Conservative surgical procedures following the precepts developed by Carpentier were used i n 127 patients. Valvar replacement was necessary in 8 patients. Operat ive mortality was 4%. Mean follow up was 8.4 +/- 5.3 years (1-23Y). Ac tuarial survival at 5 years was 90 +/- 6% and, at this time, was stabl e. No thromboembolic events occurred after conservative surgery. The r eoperation rate was 5% for those undergoing repair (6 patients). We co nclude that the functional classification developed by Carpentier is a reliable and robust approach to these complex lesions. Conservative s urgery is feasible in most of the cases presenting with congenital mit ral valvar insufficiency. Results are stable and reliable. Surgery sho uld be undertaken before the onset of left ventricular deterioration.