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

Lesions producing congenital mitral valvar stenosis are complex and of ten multiple. From 1970 to 1994, 58 patients under 12 years of age (me an 5 +/- 3.2 y) underwent surgical treatment for such malformations in our department. In order to provide a cleat understanding of the path ology, we used a classification based on anatomy and function. Echocar diography was a major tool of the preoperative investigations. The les ions were classified as follows: Normal papillary muscles: commissural fusion in 19, excess leaf-let tissue in 2, valvar ring in 12, and ann ular hypolasia in 2. Abnormal papillary muscles: parachute arrangement in 10 and hammock mitral valve in 13. Associated malformations were f ound in 63 %, the most common being multiple stenosis in the left hear t. Conservative treatment was possible in 54 patients (95 %) using the techniques developed by Carpentier. Hospital mortality was 22%, with 95% confidence limits between 13 and 36 % (13/58). Of the 13 patients with a hammock valve, 6 died in hospital. The overall mean period of f ollow up was 7.8 + 5 years. No thromboembolic events occured after con servative surgery. Late death occured in 3 %. The actuarial survival a t 5 years was 64 + 15%. Reoperation was needed for residual mitral val var stenosis in three patients or insufficiency in one. In spite of ef fective techniques to relieve mitral obstruction, 12 % of our patients need early or delayed replacement of the valve. The hospital mortalit y remains high due to the complexity of the lesions, associated with t he associated malformations. Echocardiography proved to be extremly he lpful for the functional analysis. In order to improve operative resul ts, simple and early valvar repair, even if considered palliative, see ms to be appropriate.