Abstract
Objective. Evaluation of long-term results of congenital mitral valve regurgitation repair in children.
Material and methods. 88 children with mitral valve (MV) disease underwent mitral valve repair. The mean age of patient at operation was 9.5±3.5 years. Severity of MR was grade II in 35 (40%) patients, grade III in 45 (51%) and grade IV in 8 (9%) patients. According to the functional classification of A. Carpentier, 55 patients belonged to type I, 30 patients – to type II, 3 patients – to type III. 54 (61.4%) of patients were in NYHA class II and 34 (38.6%) of patients were in NYHA class III–IV. Reconstructive surgery of MV consisted of valvuloplasty in 42 (48%) cases, annuloplasty in 13 (14%) cases, and multicomponent reconstruction was made in 33 (38%) cases. All concomitant heart defects were corrected simultaneously. The choice of surgical technique depended on the morphology of the mitral valve.
Results. There was no hospital mortality. 68 (77%) patients were examined in the long-term follow-up period from 1 to 19 years (mean 6.5 ± 4.9). The Kaplan–Mayer survival rate was 98.1 ± 1.9%. Insufficiency of MV in the long-term period was absent or was grade I in 36 (53%) patients, grade II in 24 (35%), and grade III–IV in 8 (12%) patients. Most patients (n = 60, 88%) correspond to NYHA class I–II and lead an active lifestyle, the remaining 8 (12%) patients belong to NYHA class III, they have progression of regurgitation to MV and therefore 6 patients required valve replacement in the period from 6 months to 15 years after the repair operation. Freedom from valve replacement in 19 year was 86%.
Conclusion. Reconstructive operations of the mitral valve with congenital insufficiency in children are the operation of the choice which are accompanied by high freedom from mitral valve replacement, good survival and functional state of patients in the longterm period.
References
- Bernstein D. Evaluation of the cardiovascular system. In: Behrman R.E., Kliegman R.M., Jenson H.B. (Eds) Nelson textbook of pediatrics. Philadelphia, Saunders; 2004: 1481–8.
- Carpentier A., Branchini B., Cour J.C., Asfaou E., Villani M., Deloche A. et al. Congenital malformations of the mitral valve in children. Pathology and surgical treatment. J. Thorac. Cardiovasc. Surg. 1976; 72: 854. DOI: 10.1016/S0022-5223(19)40003-2
- Bukharin V.A., Bondarev Yu.I., Kagramanov I.I., Mitina I.N., Safonova N.I., Sinev A.F., Bondarenko I.E. Surgical repair of congenital mitral valve. Russian Journal of Thoracic and Cardiovascular Surgery. 1996; 2: 23 (in Russ.).
- Banerjee A., Kohl T., Silverman N.H. Echocardiographic evaluation of congenital mitral valve anomalies in children. Am. J. Cardiol. 1995; 76: 1284–91. DOI:10.1016/s0002-9149(99)80357-9
- Séguéla P.E., Houyel L, Acar P. Congenital malformations of the mitral valve. Arch. Cardiovasc. Dis. 2011; 104: 465–79. DOI: 10.1016/j.acvd.2011.06.004
- Saperova E.V., Vakhlova I.V. Congenital heart diseases in children: incidence, risk factors, mortality. Current Pediatrics. 2017; 16 (2): 126–33 (in Russ.). DOI: 10.15690/vsp.v16i2.1713
- Ohno H., Imai Y., Terada M., Hiramatsu T. The long-term results of commissure plication annuloplasty for congenital mitral insufficiency. Ann. Thorac. Surg. 1999; 68: 537–41. DOI: 10.1016/s0003-4975(99)00515-9
- Lee C.H., Kwak J.G., Park C.S., Kim S.J., Song J.Y., Shim W.S. Long-term results after mitral valve repair in children. Eur. J. Cardio-thorac. Surg. 2010; 37 (2): 267–72. DOI: 10.1016/j.ejcts.2009.07.042
- McCarthy J.F., Neligan M.C., Wood A.E. Ten years’ experience of an aggressive reparative approach to congenital mitral valve anomalies. Eur. J. Cardiothorac. Surg. 1996; 10: 534–9. DOI: 10.1016/s1010-7940(96)80420-9
- Stellin G., Padalino M., Milanesi O., Vida V., Favaro A., Rubino M. et al. Repair of congenital mitral valve dysplasia in infants and children: is it always possible? Eur. J. Cardiothorac. Surg. 2000; 18: 74–82. DOI: 10.1016/s1010-7940(00)00457-7
- Stellin G., Padalino M.A., Vida V.L., Boccuzzo G., Orru E., Biffanti R. et al. Surgical repair of congenital mitral valve malformations in infancy and childhood: a single-center 36-year experience. J. Thorac. Cardiovasc. Surg. 2010; 140 (6): 1238–44. DOI: 10.1016/j.jtcvs.2010.05.016
- Beierlein W., Becker V., Yates R., Tsang V., Elliot M., de Leval M. et al. Long-term follow-up after mitral valve replacement in childhood: poor event–free survival in the young child. Eur. J. Cardiothorac. Surg. 2007; 31: 860–5. DOI: 10.1016/j.ejcts.2007.02.006
- Wada N., Takahashi Y., Ando M., Park In-Sam, Kikuchi T. Mitral valve replacement in children under 3 years of age. Jpn. J. Thorac. Cardiovasc. Surg. 2005; 53 (10): 545–50. DOI: 10.1007/s11748-005-0065-z
- Hisatomi K., Isomura T., Sato T., Kosuga K., Ohishi K., Katoh H. Mitral valve repair for mitral regurgitation with ventricular septal defect in children. Ann. Thorac. Surg. 1996; 62 (6): 1773–7. DOI: 10.1016/s0003-4975(96)00637-6
- Gamil E., Shaarawy M.A., Taher A.H., Refaie M.A., Alsawasany M. Early and midterm result of mitral valve repair in children. J. Am. Sci. 2015; 11 (6): 255–62. DOI: 10.1016/s0145-4145(08)79368-7
- Wood A.E., Healy D.G., Nolke L., Duff D., Oslizlok P., Walsh K. Mitral valve reconstruction in a pediatric population: late clinical results and predictors of long-term outcome. J. Thorac. Cardiovasc. Surg. 2005; 130: 66–73. DOI: 10.1016/j.jtcvs.2005.03.025
- Zhu D., Bryant R., Heinle J., Nihil M. Clinical course of isolated cleft of the mitral valve. Tex. Heart Inst. J. 2009; 36 (6): 553–6.
- Cho H.J., Ma J.S., Cho Y.K., Ahn B.H., Na K.J., Jeong I.S. Timing in resolution of left heart dilation according to the degree of mitral regurgitation in children with ventricular septal defect after surgical closure. J. Pediatr. 2014; 90: 71–7. DOI: 10.1016/j.jped.2013.06.008
- Ibezim Ch., Sarvestani A.L., Knight J.H., Qayum O., Alshami N., Turk E. et al. Outcomes of mechanical mitral valve replacement in children. Ann. Thorac. Surg. 2019; 107: 143–50. DOI: 10.1016/j.athoracsur.2018.07.069
- Ackermann K., Balling G., Eicken A., Gunther T., Schreiber C., Hess J. Replacement of the systemic atrioventricular valve with a mechanical prosthesis in children aged less than 6 years: late clinical results of survival and subsequent replacement. J. Thorac. Cardiovasc. Surg. 2007; 134: 750–6. DOI: 10.1016/j.jtcvs.2007.04.025
- Bockeria L.A., Podzolkov V.P., Hassan A. Mitral valve replacement in children: surgical approach and real possibilities. Children’s Heart and Vascular Diseases. 2004; 1: 73–81 (in Russ.).
- Baird C.W., Myers P.O., Marx G., del Nido P.J. Mitral valve operations at a high-volume pediatric heart center: evolving techniques and improved survival with mitral valve repair versus replacement. Ann. Pediatr. Card. 2012; 5: 13–20. DOI: 10.4103/0974-2069.9370
About the authors
- Dmitriy V. Kovalev, Dr. Med. Sci., Leading Researcher; ORCID
- Mikhail R. Chiaureli, Dr. Med. Sci., Professor, Chief Researcher; ORCID
- Lyale Ch. Yanybaeva, Cand. Med. Sci., Cardiologist; ORCID
- Viktor B. Samsonov, Dr. Med. Sci., Leading Researcher; ORCID
- Timur Yu. Danilov, Dr. Med. Sci., Leading Researcher; ORCID
- Vera I. Dontsova, Cand. Med. Sci., Ultrasonic Diagnostician; ORCID
- Tat’yana O. Astrakhantseva, Dr. Med. Sci., Leading Researcher; ORCID
- Marina Yu. Mironenko, Cand. Med. Sci., Head of Department of Ultrasound Diagnostics; ORCID
- Ol’ga I. Medvedeva, Dr. Med. Sci., Leading Researcher; ORCID
- Vladimir P. Podzolkov, Dr. Med. Sci., Professor, Academician of RAS, Deputy Director for Scientific Work,
Head of Department of Surgery for Older Children with Congenital Heart Defects; ORCID
