Surgical Indications and Results of Mitral Valve Repair in Pediatric Patients With Ventricular Septal Defects Accompanied by Mitral Valve Regurgitation

• Published in: The Annals of thoracic surgery Vol. 99; no. 3; pp. 891 - 897
• Main Authors: Jang, Woo Sung, MD, PhD, Kim, Woong-Han, MD, PhD, Cho, Joon Yong, MD, Choi, Kwangho, MD, Choi, Eun Seok, MD, Lee, Young Ok, MD, PhD, Kim, Gun-Jik, MD, Lee, Jeong Ryul, MD, PhD, Kim, Yong Jin, MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.03.2015
• Subjects: Cardiac Surgical Procedures - methods; Cardiothoracic Surgery; Female; Heart Septal Defects, Ventricular - complications; Humans; Infant; Male; Mitral Valve - surgery; Mitral Valve Insufficiency - complications; Mitral Valve Insufficiency - surgery; Retrospective Studies; Surgery; Time Factors; Treatment Outcome; 20
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2014.11.004

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.