Surgical experience with reparative techniques in patients with congenital mitral valvular anomalies

J. G. Coles, W. G. Williams, T. Watanabe, Kim F Duncan, H. Sherret, H. K. Dasmahapatra, R. M. Freedom, G. A. Trusler

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Abstract

Our review of an entire institutional experience with primary repair of congenital and acquired mitral valve (MV) anomalies in children with concordant atrial-ventricular-arterial connections but without atrioventricular septal defects included 48 patients (1962 to September 1986). Mitral stenosis (MS) was the predominate lesion in 24 patients, mitral incompetence in 22, and mixed in two. Most patients with MS had so-called typical congenital MS (Van Praagh) with abnormalities of all valvular components; virtual or complete absence of chordal development was a consistent finding. Other anatomic substrates (not mutually exclusive) producing MS included supramitral ring with Shone's complex (n = 5), parachute mitral valve (n = 2), hypoplastic mitral ring (n = 3), and rheumatic lesions (n = 3). The anatomic substrates producing mitral incompetence included annular dilation (n = 16; isolated in seven), leaflet prolapse (n = 7), cleft leaflet (n = 6), leaflet deficiency (n = 3), and rheumatic lesions (n = 2). Concurrent repair of associated lesions was performed in 29 (60%) patients for relief of left ventricular outflow tract obstruction (n = 16) and closure of ventricular septal defects (n = 9; double-outlet right ventricle in three). Six (12.5%) patients had previous repair of coarctation of the aorta. The operative mortality rate was 18.7% (70% confidence limits [CL]; 12.8% to 24.6%), with one death in 35 patients since 1975 (2.9%;70% CL; 0% to 5.8%). The actuarial freedom from early or late death and reoperation (± SEM) was 44.0% ± 14.8% at 8 years postoperatively. We conclude that mitral valvuloplasty and simultaneous repair of commonly associated intracardiac lesions can be accomplished with a low operative risk; residual hemodynamic lesions are common postoperatively, and account for the continuing risk of late death and reoperation.

Original languageEnglish (US)
Pages (from-to)117-122
Number of pages6
JournalCirculation
Volume76
Issue number3 II SUPPl.
StatePublished - Nov 9 1987

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Mitral Valve Stenosis
Mitral Valve Insufficiency
Mitral Valve
Reoperation
Double Outlet Right Ventricle
Ventricular Outflow Obstruction
Aortic Coarctation
Ventricular Heart Septal Defects
Prolapse
Dilatation
Hemodynamics
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Coles, J. G., Williams, W. G., Watanabe, T., Duncan, K. F., Sherret, H., Dasmahapatra, H. K., ... Trusler, G. A. (1987). Surgical experience with reparative techniques in patients with congenital mitral valvular anomalies. Circulation, 76(3 II SUPPl.), 117-122.

Surgical experience with reparative techniques in patients with congenital mitral valvular anomalies. / Coles, J. G.; Williams, W. G.; Watanabe, T.; Duncan, Kim F; Sherret, H.; Dasmahapatra, H. K.; Freedom, R. M.; Trusler, G. A.

In: Circulation, Vol. 76, No. 3 II SUPPl., 09.11.1987, p. 117-122.

Research output: Contribution to journalArticle

Coles, JG, Williams, WG, Watanabe, T, Duncan, KF, Sherret, H, Dasmahapatra, HK, Freedom, RM & Trusler, GA 1987, 'Surgical experience with reparative techniques in patients with congenital mitral valvular anomalies', Circulation, vol. 76, no. 3 II SUPPl., pp. 117-122.
Coles JG, Williams WG, Watanabe T, Duncan KF, Sherret H, Dasmahapatra HK et al. Surgical experience with reparative techniques in patients with congenital mitral valvular anomalies. Circulation. 1987 Nov 9;76(3 II SUPPl.):117-122.
Coles, J. G. ; Williams, W. G. ; Watanabe, T. ; Duncan, Kim F ; Sherret, H. ; Dasmahapatra, H. K. ; Freedom, R. M. ; Trusler, G. A. / Surgical experience with reparative techniques in patients with congenital mitral valvular anomalies. In: Circulation. 1987 ; Vol. 76, No. 3 II SUPPl. pp. 117-122.
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abstract = "Our review of an entire institutional experience with primary repair of congenital and acquired mitral valve (MV) anomalies in children with concordant atrial-ventricular-arterial connections but without atrioventricular septal defects included 48 patients (1962 to September 1986). Mitral stenosis (MS) was the predominate lesion in 24 patients, mitral incompetence in 22, and mixed in two. Most patients with MS had so-called typical congenital MS (Van Praagh) with abnormalities of all valvular components; virtual or complete absence of chordal development was a consistent finding. Other anatomic substrates (not mutually exclusive) producing MS included supramitral ring with Shone's complex (n = 5), parachute mitral valve (n = 2), hypoplastic mitral ring (n = 3), and rheumatic lesions (n = 3). The anatomic substrates producing mitral incompetence included annular dilation (n = 16; isolated in seven), leaflet prolapse (n = 7), cleft leaflet (n = 6), leaflet deficiency (n = 3), and rheumatic lesions (n = 2). Concurrent repair of associated lesions was performed in 29 (60{\%}) patients for relief of left ventricular outflow tract obstruction (n = 16) and closure of ventricular septal defects (n = 9; double-outlet right ventricle in three). Six (12.5{\%}) patients had previous repair of coarctation of the aorta. The operative mortality rate was 18.7{\%} (70{\%} confidence limits [CL]; 12.8{\%} to 24.6{\%}), with one death in 35 patients since 1975 (2.9{\%};70{\%} CL; 0{\%} to 5.8{\%}). The actuarial freedom from early or late death and reoperation (± SEM) was 44.0{\%} ± 14.8{\%} at 8 years postoperatively. We conclude that mitral valvuloplasty and simultaneous repair of commonly associated intracardiac lesions can be accomplished with a low operative risk; residual hemodynamic lesions are common postoperatively, and account for the continuing risk of late death and reoperation.",
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N2 - Our review of an entire institutional experience with primary repair of congenital and acquired mitral valve (MV) anomalies in children with concordant atrial-ventricular-arterial connections but without atrioventricular septal defects included 48 patients (1962 to September 1986). Mitral stenosis (MS) was the predominate lesion in 24 patients, mitral incompetence in 22, and mixed in two. Most patients with MS had so-called typical congenital MS (Van Praagh) with abnormalities of all valvular components; virtual or complete absence of chordal development was a consistent finding. Other anatomic substrates (not mutually exclusive) producing MS included supramitral ring with Shone's complex (n = 5), parachute mitral valve (n = 2), hypoplastic mitral ring (n = 3), and rheumatic lesions (n = 3). The anatomic substrates producing mitral incompetence included annular dilation (n = 16; isolated in seven), leaflet prolapse (n = 7), cleft leaflet (n = 6), leaflet deficiency (n = 3), and rheumatic lesions (n = 2). Concurrent repair of associated lesions was performed in 29 (60%) patients for relief of left ventricular outflow tract obstruction (n = 16) and closure of ventricular septal defects (n = 9; double-outlet right ventricle in three). Six (12.5%) patients had previous repair of coarctation of the aorta. The operative mortality rate was 18.7% (70% confidence limits [CL]; 12.8% to 24.6%), with one death in 35 patients since 1975 (2.9%;70% CL; 0% to 5.8%). The actuarial freedom from early or late death and reoperation (± SEM) was 44.0% ± 14.8% at 8 years postoperatively. We conclude that mitral valvuloplasty and simultaneous repair of commonly associated intracardiac lesions can be accomplished with a low operative risk; residual hemodynamic lesions are common postoperatively, and account for the continuing risk of late death and reoperation.

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