Original article
Congenital heart surgery
Surgical Indications and Results of Mitral Valve Repair in Pediatric Patients With Ventricular Septal Defects Accompanied by Mitral Valve Regurgitation

https://doi.org/10.1016/j.athoracsur.2014.11.004Get rights and content

Background

Ventricular septal defects (VSDs) can be accompanied by mitral regurgitation (MR) owing to chronic volume overload or mitral valve (MV) abnormalities. This study investigates the surgical indications, results, and natural course of pediatric VSD patients with MR.

Methods

One hundred seven patients (median age, 4.5 months; median body weight, 6.2 kg; M:F = 46:61) who had VSD with accompanying MR between 2002 and 2012 were retrospectively analyzed and classified into two groups: group I, MV repair group; group II, no MV repair group.

Results

Of 107 patients, 48 patients (44.9%) required MV repair. Annular dilatation (n = 46) and anterior MV prolapse (n = 35) were the representative MV diseases in group I and their incidences were higher than in group II (n = 26 and n = 6, respectively; both p < 0.001). Increased preoperative z values of MV annulus, and mean diastolic and systolic left ventricle internal diameters were observed in group I (1.9 ± 1.0, 3.4 ± 1.3, and 3.1 ± 1.3, respectively) in comparison with group II (1.0 ± 0., 2.6 ± 1.7, and 2.3 ± 1.7, respectively; p < 0.001, p = 0.02, and p = 0.024, respectively). Posteromedial commissure annuloplasty in 23 patients and posterior annuloplasty in 19 patients were the most commonly used techniques to repair the MV; no reoperations were performed owing to MR. In group I, all patients showed an MR grade of 2 or less during the follow-up period. In group II, all patients showed the same or lower MR degree.

Conclusions

Mitral valve repair in pediatric VSD patients with accompanying MR is a feasible and durable procedure with growth potential.

Section snippets

Study Population

This study protocol was approved by our institutional review board, and all procedures were performed in accordance with our institutional guidelines for the protection of patient confidentiality. The requirement for patient’s consent was waived owing to the retrospective nature of this study.

Between February 2002 and December 2012, 1,898 patients presented with VSD in two hospitals. Among them, 107 patients (5.6%, 46 males and 61 females) who showed accompanying MR during the same period were

Clinical Outcomes

The median age and body weight at surgery was 4.5 months (range, 2.3 to 9.2 months) and 6.4 kg (range, 4.8 to 8.1 kg), respectively. There were 72 patients with perimembranous type VSD, 22 patients with doubly committed juxtaarterial type VSD, 11 patients with muscular outlet type VSD, and 2 patients with total conal defect VSD.

Among the 107 pediatric VSD patients who presented with MR, 48 patients (44.9%, M:F = 20:28) required MV repair (group I): 7 patients with preoperative MR grade 1

Comment

In this study, we found that MV repair in pediatric VSD patients with MR was a feasible and procedure allowing appropriate growth potential for the MV. In addition, the preoperative dilated MV annulus and left ventricular volume was shown to be normalized after VSD closure at the latest follow-up. Furthermore, we also found that MV repair in patients with MR grade 2 showed a better likelihood of MR grade improvement than those without MV repair at the latest follow-up.

Mitral valve repair for

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