Mitral valve repair in children

  • E.M. Delmo Walter
  • R. Hetzer


Surgical management of mitral valve disease in infants and children has been a major therapeutic challenge for many years. It poses special surgical difficulties because of the wide spectrum of morphological abnormalities requiring meticulous modifications of the valve repair techniques, a high incidence of associated cardiac anomalies, and relatively limited experience in each surgical center. At our institution, mitral valve (MV) reconstruction is the preferred technique for any kind of MV disease in infants, children, and adolescents. This avoids the need for valve replacement with all its drawbacks, particularly in infants and small children, in the face of the complete lack of prostheses suitable for this age group. Even when the primary repair result is not optimal, time is gained for repeated repair until an appropriate adult-size prosthesis can be implanted. We believe that reconstruction allows for valve growth without the need of anticoagulation. This is best achieved by using a spectrum of repair techniques applied individually and avoiding any prosthetic material. We have reviewed our 20-year experience with surgical reconstruction of the MV in pediatric age groups to assess our techniques and determine early and long-term survival and freedom from reoperation and valve replacement.


Mitral Valve Papillary Muscle Mitral Stenosis Mitral Valve Repair Mitral Valve Disease 
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  1. 1.
    Murakami T, Yagihara T, Yamamoto F, Uemura H, Yamashita K, Ishizaka T (1998) Artificial chordae for mitral valve reconstruction inn children. Ann Thorac Surg 65:1377–1380PubMedCrossRefGoogle Scholar
  2. 2.
    Aharon AS, Laks H, Drinkwater DC, Chugh R, Gates RN, Grant PW, Permut LC, Ardehali A, Rudis E (1994) Early and late results of mitral valve repair in children. J Thorac Cardiovasc Surg 107(5):1262–1270PubMedGoogle Scholar
  3. 3.
    Carpentier A (1994) Congenital malformation of the mitral valve. In: Stark, J, de Leval M (eds) Surgery for congenital heart defects. WB Saunders, Philadelphia pp 599–614Google Scholar
  4. 4.
    Lorier G, Kalil RA, Barcellos C, Teleo N, Hoppen GR, Netto AH, Prates PR, Vinholes SK, Prates PR, Sant Anna JRM, Nesralla LA (2001) Valve repair in children with congenital mitral lesions: late clinical results. Pediatr Cardiol 22:44–52PubMedCrossRefGoogle Scholar
  5. 5.
    Naoki Yoshimura, Masahiro Yamaguchi, Yoshihiro Oshima, Shigeteru Oka, Yoshio Ootaki, Hiroshisa Murakami, Teruo Tei, Kyoichi Ogawa (1999) Surgery for mitral valve disease in the pediatric age group. J Thorac Cardiovasc Surg 118(1):99–106CrossRefGoogle Scholar
  6. 6.
    Hetzer R, Delmo Walter EMB,Huebler M, Alexi-Meskishvili V, Weng Y, Nagdyman N, Berger F. (2008) Modified surgical techniques and long-term outcome of mitral valve reconstruction in 111 children. Ann Thorac Surg 86:604–613PubMedCrossRefGoogle Scholar
  7. 7.
    Lessana A, Carbone C, Romano M, Palsky E, Quan YH, Escorsin M, Jegier B, Ruffenach A, Lutfalla G, Aime F, Guerin F (1990) Mitral valve repair: results and the decision-making process in reconstruction. Report of 275 cases. J Thorac Cardiovasc Surg 99(4):622–630PubMedGoogle Scholar
  8. 8.
    Kumar AS, Rao PN, Saxena A (1997) Mitral valve reconstruction: eight years’ experience in 531 patients. J Heart Valve Dis 6 (6):591–593PubMedGoogle Scholar
  9. 9.
    McCarthy JF, Neligan MC, Wood AE. (1996) Ten years’ experience of an aggressive reparative approach to congenital mitral valve anomalies. Eur. J. Cardio-thoracic Surg (7):534–539Google Scholar
  10. 10.
    Sousa UM, Gallenti L, Lacour-Gayet F, Piot D. Seraf A, Brumiax J, Comas J, roussin R, Touchot A, Binet JP, Planche C (1995) Surgery for congenital mitral valve disease in the first year of life. J Thorac Cardiovasc Surg 109(1):164–176CrossRefGoogle Scholar
  11. 11.
    Stellin G, Padalino M, Milanesi O, Vida V, Favaro A, Rubino M, Bifafanti R, Casarotto D (2000) Repair of congenital mitral valve displasia in infants and children:is it always possible? Eur. J. Cardio-thoracic Surg 18 (1):74–82CrossRefGoogle Scholar
  12. 12.
    Prifti E, Vanini V, Bonacchi M, Frati G, Bernabei M, Giunti G, et al. (2002) Repair of congenital malformations of the mitral valve: early and midterm results. Ann Thorac Surg 73:614–621PubMedCrossRefGoogle Scholar
  13. 13.
    Chauvaud S, Fuzellier JF, Houel R, Berrebi A, Mihaileanu S, Carpentier A (1998) Reconstructive surgery in congenital mitral valve insufficiency (Carpentier’s techniques): long-term results. J Thorac Cardiovasc Surg 115:84–93PubMedCrossRefGoogle Scholar
  14. 14.
    Chauvaud SM, Mihaileanu SA, Gaer JAR, Carpentier A (1997) Surgical treatment of mitral valvar insufficiency. Cardiol Young 7:5–14Google Scholar
  15. 15.
    Wood AE, Healy DG, Nolke L, Duff D, Oslizlok P, Walsh K (2005) Mitral valve reconstruction in pediatric population: Late clinical results and predictors of long outcome. J Thorac Cardiovasc Surg 130(1):66–73PubMedCrossRefGoogle Scholar
  16. 16.
    Zias EA, Mavroudis C, Backer CI, Kohr LM, Gotteiner NI, Rocchini AP (1998) Surgical repair of the congenitally malformed mitral valve in indfants and children. Ann Thorac Surg 66:1551–1559PubMedCrossRefGoogle Scholar
  17. 17.
    Uva MS, Galletti L, Gayet FL, et al. (1995) Surgery for congenital mitral valve disease in the first year of life. J Thorac Cardiovasc Surg 109:164–176PubMedCrossRefGoogle Scholar
  18. 18.
    Ohno H, Imai Y, Terada M, Hiramatsu T (1999) The long term results of commissure plication annuloplasty for congenital mitral insufficiency. Ann Thorac Surg 68(2):537–541PubMedCrossRefGoogle Scholar
  19. 19.
    Komoda T, Hübler M, Siniawski H, Hetzer R (2000) Annular stabilization in mitral repair without a prosthetic ring. J Heart Valve Dis 9(6):776–782PubMedGoogle Scholar
  20. 20.
    Moran AM, Däbritz S, Keanne JF, Mayer JE (2000) Surgical management of mitral regurgitation after repair of endocardial cushion defects early and midterm results. Circulation 102:III160–III165PubMedGoogle Scholar
  21. 21.
    Thieme C, Frescura C, Daliento L (1986) The pathology of the congenitally malformed mitral valve. In: Marcelletti C, Anderson RM, Becker AE, Corno A, Di Donato RM, Mazzera E (eds) Pediatric cardiology Churchhill-Livingstone New York, pp 225–239Google Scholar
  22. 22.
    Brown JW, Ruzmetov M, Palaniswamy V, Hoyer M, Girod D, Rodefeld D, Turrentine MW (2005) Operative results and outcomes in children with Shone’s anomaly. Ann Thorac Surg 79:1358–1365PubMedCrossRefGoogle Scholar
  23. 23.
    Tulloh RM, Bull C, Elliott MJ, Sullivan ID (1995) Supravalvar mitral stenosis: risk factors for recurrence or death after resection. Br Heart J 73:164–168PubMedCrossRefGoogle Scholar
  24. 24.
    Serraf A, Zoghbi J, Belli E, et al. (2000) Congenital mitral stenosis with or without associated defects: an evolving surgical strategy. Circulation 102(Suppl III):166–171Google Scholar
  25. 25.
    Brown JW, Ruzmetov M, Vijay P, Rodefeld MD, Turrentine MW (2003) Surgery for aortic stenosis in children: a forty-year experience. Ann Thorac Surg 76:1398–1411PubMedCrossRefGoogle Scholar
  26. 26.
    Minakata K, Dearani JA, Nishimura RA, Maron BJ, Danielson GK (2004) Extended septal myectomy for Hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae. J Thorac Cardiovasc Surg 127(2):481–489PubMedCrossRefGoogle Scholar
  27. 27.
    Muehrcke DD, Cosgrove DM 3rd, Lytle BW, Taylor PC, Burgar AM, Durnwald CP, Loop FD (1997) Is there an advantage to repairing infected mitral valve. Ann Thorac Surg 63(6):1718–1724PubMedCrossRefGoogle Scholar
  28. 28.
    Talwar S, Rajesh MR, Subramanian A, Saxena A, Kumar S (2005) Mitral valve repair in children with rheumatic heart disease. J Thorac Cardiovasc Surg 129(4):875–879PubMedCrossRefGoogle Scholar
  29. 29.
    Delmo Walter EM, Musci M, Nagdyman N, Huebler M, Berger F, Hetzer R (2007) Mitral valve repair for infective endocarditis in children. Ann Thorac Surg 84:2059–2065PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • E.M. Delmo Walter
    • 1
  • R. Hetzer
    • 2
  1. 1.Department of Cardiothoracic and Vascular SurgeryDeutsches Herzzentrum BerlinBerlinGermany
  2. 2.Deutsches Herzzentrum BerlinCharité Medical University BerlinBerlinGermany

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