Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-24T05:07:44.386Z Has data issue: false hasContentIssue false
  • English
  • Français

Reconstruction of the mitral valve in children— long-term follow-up in 63 cases

Published online by Cambridge University Press:  19 August 2008

Fause Attie ,
Carlos Zabal ,
Alejandro Juárez ,
Alfonso Buendía-Hernández ,
Rodolfo Barragán ,
Juan Calderón  and
Miguel Mini-Miranda
Fause Attie*
Affiliation:
From the Instituto Nacional de Cardiologla “Ignacio Chdvez,” México
Carlos Zabal
Affiliation:
From the Instituto Nacional de Cardiologla “Ignacio Chdvez,” México
Alejandro Juárez
Affiliation:
From the Instituto Nacional de Cardiologla “Ignacio Chdvez,” México
Alfonso Buendía-Hernández
Affiliation:
From the Instituto Nacional de Cardiologla “Ignacio Chdvez,” México
Rodolfo Barragán
Affiliation:
From the Instituto Nacional de Cardiologla “Ignacio Chdvez,” México
Juan Calderón
Affiliation:
From the Instituto Nacional de Cardiologla “Ignacio Chdvez,” México
Miguel Mini-Miranda
Affiliation:
From the Instituto Nacional de Cardiologla “Ignacio Chdvez,” México
*
Dr. Fause Attie, Instituto Nacional de Cardiologia “Ignacio Chávez”, Juan Badiano 1, Tlalpan, 14080 México, D.F., México. Tel. (5) 573- 2911; Fax. (5) 573-0994.
Get access Rights & Permissions [Opens in a new window]

Summary

Between June 1985 and June 1991, 63 children underwent surgical reconstruction of the mitral valve for rheumatic (46 cases), congenital (12 cases) and myxoid (five cases) disease. The ages ranged from two to 18 years (mean 14.1±3.7 years). Valvar dysfunction was classified according to its pathophysiological abnormalities. A group of four cases presented with regurgitation secondary to lesions located in the valvar structures but with normal motion of the leaflets. In a second group of 14 cases, mitral regurgitation was due to prolapsed leaflets because of lesions located mainly in the subvalvar structures. A third group was formed by 35 patients with mitral regurgitation with restricted motion of the leaflets due to lesions in the valvar and subvalvar structures. The final group, of 10 cases, presented with mitral stenosis. The overall surgical mortality rate was 4.7% (3/63), and follow-up data were available in all survivors from one to 96 months (mean 33.4±25.4). Four cases underwent reoperation due to residual incompetence, one case due to bacterial endocarditis, and two more are scheduled for replacement of the valve due to unfavorable evolution, giving an overall rate of reoperation of 4.3% per patient/year. One patient died in the period following valvar replacement (late mortality rate of 0.6% per patient/year). Thromboembolism occurred in four cases in the absence of anticoagulation; three of them were in atrial fibrillation (late thromboembolic rate 2.4% per patient/year). Prior to surgery, 28 cases were in functional class II of the New York Heart Association, 34 patients were in class III and one patient in class IV. At the end of the follow-up period, 49 patients were in class I, seven in class II and four in functional class III (p<0.0001). The cardiothoracic ratio before surgery ranged from 0.40 to 0.81 (mean 0.60±0.07) and, after surgery, the values ranged from 0.40 to 0.79 (mean 0.55±0.07) (p<0.0001). Randomized late echocardiographic evaluation in 24 cases revealed residual mild mitral regurgitation in 20 cases, moderate in two and severe in two. The latter are scheduled for valvar replacement. There were no significant differences in the surgical results among the four groups. Reconstruction of the mitral valve, therefore, provides stable functional results with low surgical and late mortality, as well as an acceptable rate of reoperation irrespective of the lesions of the valvar apparatus.

Keywords

Mitral valvar diseasecardiac surgerysurgical valvoplastyrheumatic heart disease
Type
Original Articles
Information
Cardiology in the Young , Volume 4 , Issue 3 , July 1994 , pp. 285 - 290
Copyright
Copyright © Cambridge University Press 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Carpentier, A, Deloche, A, Dauptain, J, Soyer, R, Blodeau, P, Piwnica, A, Dubost, C.A new reconstructive operation for correction of mitral and tricuspid insufficiency. J Thorac Cardiovasc Surg 1971, 61: 1–13.CrossRefGoogle ScholarPubMed
Carpentier, A, Relland, J, Deloche, A, Fabiani, JN, d'Allaines, C, Blondeau, P, Piwnica, A, Chauvaud, S, Dubost, C.Conservative management of the prolapsed mitral valve. Ann Thorac Surg 1978; 26: 294–302.CrossRefGoogle ScholarPubMed
Carpentier, A, Chauvaud, S, Fabiani, JN, Deloche, A, Relland, J, Lessana, A, d'Allaines, C, Blondeau, P, Piwnica, A, Dubost, C.Reconstructive surgery of mitral valve incompetence. Ten-year appraisal. J Thorac Cardiovasc Surg 1980; 79: 338–348.Google Scholar
Carpentier, A.Cardiac valve surgery—the “French correction.” J Thorac Cardiovasc Surg 1983; 86: 323–337.Google Scholar
Lillehei, CW, Gort, VL, Dewall, RA, Varco, RL.Surgical correction of pure mitral insufficiency by annuloplasry under direct vision. Lancet 1957; 77:446–449.Google Scholar
Meredino, KA, Bruce, RA.One hundred seventeen surgically treated cases of valvar rheumatic heart disease: with preliminary report of two eases of mitral regurgitation treated under direct vision with aid of a pump-oxygenator. J Am Med Assoc 1957; 64: 749–755.CrossRefGoogle Scholar
Spencer, FC, Colvin, SB, Culliford, AT.Experience with the Carpentier techniques of mitral valve reconstruction in 103 patients (1980–1985).J Thorac Cardiovasc Surg 1985; 90:341–350.CrossRefGoogle Scholar
Duran, CC, Revuelta, JM, Gaite, L, Alonso, C, Fleitas, MG.Stability of mitral reconstructive surgery at 10–12 year for predominantly rheumatic valvar disease. Circulation 1988; 78(Suppl Iyes): I 91– I 96.Google Scholar
Galloway, AC, Colvin, SB, Baumann, C, Esposito, R, Vohra, R, Harry, S, Freedberg, R, Kronzon, I, Spencer, FC.Long-term results of mitral valve reconstruction with Carpentier techniques in 148 patients with mitral insufficiency. Circulation 1988; 78(Suppl Iyes): I 97–I 105.Google Scholar
Reed, GE, Poolly, RW, Moggio, RA.Durability of measured mitral annuloplasty. Seventeen-year study. J Thorac Cardiovasc Surg 1980; 79: 321–325.CrossRefGoogle ScholarPubMed
Attie, F, Kuri, J, Zanoniani, C, Renteria, V, Buendía, A, Oyseyevitz, J, López-Soriano, F, García Cornejo, M, Martínez Ríos, MA. Mitral valve replacement in children with rheumatic heart disease. Circulation 1981; 64: 812–817.CrossRefGoogle ScholarPubMed
Attie, F, López-Soriano, F, Oyseyevitz, J, Martínez, J, Gil-Moreno, M, Buend ía, A, Chávez-Domtínguez, R, Richheimer, R.Late results of mitral valve replacement with Björk-Shilley prosthesis in children under 16 years of age. J Thorac Cardiovasc Surg 1986; 91: 754–758.CrossRefGoogle Scholar
Carpentier, A, Branchini, B, Cour, JC, Asfaou, E, Villani, M, Deloche, A, Relland, J, d'Allaines, Cl, Blondeau, PH, Piwnica, A, Parenzan, L, Brom, G.Congenital malformations of the mitral valve in children. J Thorac Cardiovasc Surg 1976; 72: 854–866.CrossRefGoogle ScholarPubMed