Supramitral Ring: Good Prognosis in a Subset of Patients With Congenital Mitral Stenosis

• Published in: The Annals of thoracic surgery Vol. 81; no. 3; pp. 997 - 1001
• Main Authors: Collison, Sathiakar Paul, Kaushal, Sunil Kumar, Dagar, Kulbushan Singh, Iyer, Parvathi Unninayar, Girotra, Sumir, Radhakrishnan, Sitaraman, Shrivastava, Savitri, Iyer, Krishna Subramony
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2006; Elsevier Science
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Child; Child, Preschool; Electrocardiography; Endocardial and cardiac valvular diseases; Female; Heart; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - surgery; Humans; Infant; Male; Medical sciences; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Mitral Valve Stenosis - congenital; Mitral Valve Stenosis - diagnostic imaging; Mitral Valve Stenosis - surgery; Prognosis; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the respiratory system; Ultrasonography; 20; Human; Prognosis; Treatment; Congenital; Cardiac valvular disease; Respiratory disease; Ring; Surgery; Cardiovascular disease; Patient; Thorax; Mitral stenosis
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2005.06.079

Management of congenital stenotic mitral valvular abnormalities remains an important therapeutic challenge. Supramitral ring constitutes a small but inadequately described subset that has a relatively good outcome with appropriate management. Between 1996 and 2004, 15 patients with supramitral ring were managed in this institution. The demographic and clinical features, diagnostic modalities, morphology of the rings, and the surgical management were studied retrospectively. Accurate preoperative diagnosis was possible by transthoracic echocardiography in 11 patients (73%). The associated anomalies were ventricular septal defects in 8 patients (53%) and abnormalities of the left ventricular outflow tract in 7 patients (47%). A circumferential supramitral ring, separate from the mitral valve, was present in 8 patients (53%). In the remaining, the ring was attached circumferentially to the anterior and the posterior mitral leaflets and was most densely adherent at the posteroinferior commissure in 4 of these 7 patients (57%). Complete excision of ring was possible in all cases, without damage to the mitral valve. There was 1 in-hospital death (6%). At a mean follow-up of 30 months, 14 survivors continue to do well, with no significant recurrence of mitral stenosis. Patients with supramitral ring constitute a subset of patients with congenital mitral stenosis who have a relatively good prognosis. In many cases, the supramitral ring is entirely separate from the mitral valve, and when attached, it is usually most prominent at the posteroinferior commissure. In both cases, complete resection is surgically feasible and usually provides lasting relief.