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DOI: 10.1055/s-2005-862085
Early results of complex mitral-valve-reconstruction in pediatric patients
Objectives: Study-aim was the retrospective evaluation of results in mitral-valve-reconstruction (MVR) in the pediatric population without the use of prosthetic material.
Material and Methods: Eleven patients (mean-age 4.5±1.5 years, range 0.2–14.7 years) underwent MVR between 01/2002 and 09/2004. Indications for surgery were mitral-stenosis (n=4; 36.7%), mitral-incompetence (n=5; 45.5%) or the combination of both (n=2, 18.2%). Three patients (27.3%) had previous operations. One patient required MVR after VSD-closure and two patients with Shone-complex after coarctation repair. All patients were repaired without the use of prosthetic material with different individually adopted surgical techniques like commissurotomy plus chordae-repair (n=4), leaflet repair (n=3), leaflet repair plus anuloplasty (n=2), simple anuloplasty (n=1) or comissurotomy plus excision of a supravalvar membrane (n=1).
Results: There was no mortality or indication for reoperation. Stenosis improved significantly from grade 3.3±0.3 to 0.2±0.2; mitral-incompetence was diminished from grade 2.9±0.4 to 1.5±0.3. Comparison of intraoperative TEE and follow-up echocardiograms showed no relevant progression during follow-up. All patients are asymptomatic, LV-function was well presevered over a mean follow-up-period of 1.2±0.2 years.
Conclusions: Mitral-valve-reconstruction avoiding the use of prosthetic material is always the first choice in growing pediatric patients. Most of the lesions are of complex anatomical origin and residual incompetence or stenosis after surgery are common. This is well accepted in order to preserve valvar growth potential without the need of anticoagulation in these young patients.
Until now our results using an adopted approach to patients anatomy has given us good functional results so far, but reoperations will be inevitably necessary, hopefully in the adult age.