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Surgical treatment of congenital mitral valvar insuffciency: “The Hôpital Broussais” experience

Published online by Cambridge University Press:  19 August 2008

Sylvan M. Chauvaud ,
Serban A. Milhaileanu ,
Julian A. R. Gaer  and
Alain C. Carpentier
Sylvan M. Chauvaud*
Affiliation:
Department of Cardivascular Surgery, Hôpital Broussais, Paris, France
Serban A. Milhaileanu
Affiliation:
Department of Cardivascular Surgery, Hôpital Broussais, Paris, France
Julian A. R. Gaer
Affiliation:
Department of Cardivascular Surgery, Hôpital Broussais, Paris, France
Alain C. Carpentier
Affiliation:
Department of Cardivascular Surgery, Hôpital Broussais, Paris, France
*
S Chauvaud, Hôpital Broussais, Service de Chirurgie Cardiovasculaire, 96 rue Didot, 75014 Paris, France. Tel: 33 1 43 95 93 42, Fax: 33 1 43 95 93 42
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Abstract

There are many congenital malformations of the mitral valve which produce valvar insufficiency. From a surgical point of view, systems based exclusively on anatomic analysis are not always entirely appropriate for assessment of these lesions. With this in mind, Carpentier proposed a functional approach for analysis based upon the motion of the valvar leaflets. From 1969 to 1994, 135 children under the age of 12 (mean age: 5.8 + 3.15 Y, 0.6–12Y) underwent surgery in our department, basing treatment on such analysis. Since motion of the leaflets during the operation is compromised by cardioplegia, and sometimes exposure can be however difficult, preoperative echocardiography was a mandatory part of the diagnostic cascade.

Normal motion of the leaflets was present in 41 patients, with deformation of the annulus in 14, a cleft in 21, and partial agenesis in 6. Prolapse of leaflets was present in 42 patients. Leaflet motion was restricted in 28 patients. These were divided in two groups, one with normal papillary muscles and commissural fusion or short cords. The other with abnormal papillary muscles producing a parachute arrangement in 6 and a hammock valve in 9. Associated lesions were present in 47% of the patients. Conservative surgical procedures following the precepts developed by Carpentier were used in 127 patients. Valvar replacement was necessary in 8 patients. Operative mortality was 4%. Mean follow up was 8.4 ± 5.3 years (1–23Y). Actuarial survival at 5 years was 90 ± 6% and, at this time, was stable. No thromboembolic events occurred after conservative surgery. The reoperation rate was 5% for those undergoing repair (6 patients). We conclude that the functional classification developed by Carpentier is a reliable and robust approach to these complex lesions. Conservative surgery is feasible in most of the cases presenting with congenital mitral valvar insufficiency. Results are stable and reliable. Surgery should be undertaken before the onset of left ventricular deterioration.

Keywords

Congenital mitral valvar insufficiencyconservative valvar surgery
Type
Review Article
Information
Cardiology in the Young , Volume 7 , Issue 1 , January 1997 , pp. 5 - 14
Copyright
Copyright © Cambridge University Press 1997

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References

1.Davachi, F, Moller, JH, Edwards, JE. Disease of the mitral valve in infancy. An anatomic analysis of 55 cases. Circulation; 1971;43:565–569.Google Scholar
2.Van, Praagh R, Chacko, KA, O'Connor, B. Surgical pathology of malformations of the mitral valve. In: Crupi, Giancarlo, Parenzan, Lucio, Anderson, Robert H.. (eds) “Perspectives in pediatric cardiology” Futura Publishing Company, Inc Mount Kisco, New York 1990;Tome3 pp 91–96.Google Scholar
3.Berguis, J, Kirklin, JW, Edward, JE, Titus, JL. Surgical anatomy of isolated congenital mitral insufficiency. J Thorac Cardiovasc Surg 1964;47:791–795.Google Scholar
4.Edwards, JE, Carey, LS, Neufeld, HN, Lester, RG. Congenital heart disease. Correlation of pathologic anatomy and angiography. WB Saunders Company - Phildelphia, London 1965 pp 783–792.Google Scholar
5.Wenink, ACG, Gittenberger, De, Groot, AC, Brom, AG. Developmental considerations of mitral valve anomalies. Int J Cardiol 1986;11:85–93.Google Scholar
6.Carpentier, A, Branchini, B, Cour, JC, Asfaou, E, Villani, M, Deloche, A, Relland, J.D'Allaine, C, Blondeau, P, Piwnica, A, Parenzan, L, Brom, G.. Congenital malformation of the mitral valve in children. J Thorac Cardiovasc Surg 1976;72:854–860.CrossRefGoogle Scholar
7.Carpentier, A. Mitral valve reconstructive surgery. In: Jamieson, SW, Shumway, NE (eds) “Operative Surgery”, Butterworths London, 1986, 4th ed pp 405–414.Google Scholar
8.Grenadiere, E, Sahn, DJ, Valdes, Cruz LM, Allen, HD, Lima, CO, Goldbert, SJ. Two-dimensional echo Doppler study of congenital disorders of the mitral valve. Am Heart J 1984;107:319–324.Google Scholar
9.Ranganathan, N, Lam, JHC, Wigle, ED, Silver, MD. Morphology of the human mitral valve. The valve leaflet. Circulation 1970; 41: 459–462.Google Scholar
10.Rowlatt, UF, Rimoldi, HJA, Lev, M. The quantitative anatomy of the child's heart. Pediat Clin North Amer 1963;10:499–588.Google Scholar
11.Di Segni, E, Edwards, JE, Dorst, JP, Edwards, JK, Cleft anterior leaflet of rhe mitral valve with intact septa. A study of twenty cases. Am J Cardiol 1983:51:915–917Google Scholar
12.Di Segni, E, Bass, JL, Lucas, RV, Einzing, S. Isolated cleft mitral valve. A variety of congenital mitral regurgitation identifed by two bidimensional echocardiography. Am J Cardiol 1983:51:927–930.Google Scholar
13.Creech, O, Ledbetter, MK, Reemtsma, K. Congenital insufficiency with a cleft in the posterior leaflet. Circulation; 1962;25:390–392.Google Scholar
14.Carpentier, A. Surgical anatomy and management of the mitral components of atrioventricular canal defects. In: Anderson, RH, Shinebourne, EA Edit, ‘Pediatric Cardiology 1977’ Churchill Livingstone London 1978, Chapter 54 pp 477–490.Google Scholar
15.Carpentier, A. Congenital malformations of the mitral valve. In: Stark, J, De Leval, M. (eds) “Surgery for congenital heart defects” Grune and Statton Inc, London 1983, Chapter 36 pp 467–482.Google Scholar
16.Layman, TE, Edwards, JE. Anomalous mitral arcarde. A type of congenital mitral insufficiency. Circulation 1967;35:389–391.CrossRefGoogle Scholar
17.Trowitzch, E, Bano-Rodrigo, A, Burger, BM, Colan, SD, Sanders, SP. Two-dimensional echographic findings in double orifice mitral valve. J Am Coll Cardiol 1985;6:383–389Google Scholar
18.Ruschaudt, DG, Bharati, S, Lev, M. Mitral valve malformations of Ebstein type in absence of corrected transposition. Am J Cardiol 1976;38:109–112.Google Scholar
19.Zweng, TN, Bluett, MK, Mosca, R, Callow, LB, Brove, EL. Mitral valve replacement in the first 5 years of life. Ann Thorac Surg; 1989;47:720–723.Google Scholar
20.Chauvauds, S, Jebara, V, Chachques, JC, El Asmer, B, Mihaileanu, S, Perier, P, Dreyfus, G, Relland, J, Couetil, JP, Carpentier A Valve extension with Glutaraldehyde-preserved autologous pericaridium. Results in mitral valve repair J Thorac Cardiovasc Surg 1991;102:171–178.Google Scholar
21.Almeida, RS, Eliott, MJ, Roobinson, PJ. Surgery for congenital abnormalities of the mitral valve at the Hospital for Sick Children. J Cardiovasc Surg 1988;29:95–103.Google Scholar
22.Carpentier, A. The ‘sliding leaflet technique’. Le Club Mitrale Newsletter, Promedica International Publ 1, 1988.Google Scholar
23.Nojek, AD, Figuera, FA. Surgical treatment of the “parachute mitral valve” complex in infancy. J Thorac Cardiovasc Surg. 1978;19:401–405.Google Scholar
24.Okita, Y, Miki, S, Dusuhara, K, Ueda, Y, Tahata, T, Tsukamoto, Y, Komeda, M, Yamanaka, K, Shiraishi, S, Tatsuta, N, Koie, H. Early and late results of reconstructive operation for congenital mitral regurgitation in pediatric age group. J Thorac Cardiovasc Surg 1988;96:294–306.CrossRefGoogle Scholar
25.Stellin, G, Bortolotti, U, Mazzucco, A, Graggian, G, Guerra, F, Daliento, L, Livi, U, Gallucci, V. Repair of congenitally malformed mitral valve in children. J Thorac Cardiovasc 1988;95:480–485.Google Scholar
26.Coles, JG, Williams, WG, Watanabe, T, Ducan, KF, Sherret, H, Dasmahapatra, HK, Freedom, RM, Trusler, GA. Surgical experience with reparative techniques in patients with congenital mitral valvular anomalies. Circulation 1987:76:111–117.Google Scholar
27.Silver, MM, Pollock, J, Silver, MD, Willimas, WG, Trusler, GA. Calcification in porcine xenograft valves in children. Am J Cardiol 1980;45:685–690.Google Scholar
28.El, Makhlouf A, Friedli, B, Oberhansli, I.. Prosthetic heart valve replacement in children. Results and follow–up of 273 patients. J Thorac Cardiovasc Surg 1987;93:80–85.Google Scholar
29.Bordon, AN, Soule, L, Reitz, B, Gott, BL, Gardner, TJ. Five year follow-up after valve replacement with the St Jude medical valve in infants and children. Circulation 1986;74 (Suppl I):110–114.Google Scholar
30.Gardner, TJ, Roland, JM, Neill, CA, Donahoo, JS. Valve replacement in children. A fifteen–year perspective. J Thorac Cardiovasc Surg 1982;83:178–181.Google Scholar
31.Kadoba, K, Jonas, RA, Mayer, JE, Castaneda, AR.. Mitral valve replacement in the first year of life. J Thorac Cardiovasc Surg 1990;100:762–768Google Scholar
32.Sousa, M, Galletti, L, Lacour, GAYet, F, Piot, D, Serraf, A, Bruniaux, J, Comas, J, Roussin, R, Touchot, A, Binet, JP, Planche, C. Surgery for congenital mitral valve disease in the first year of life. J Thorac Cardiovasc Surg 1995;109:164–176.Google Scholar