Surgical reconstruction techniques for mitral valve insufficiency from lesions with restricted leaflet motion in infants and children.

Objectives: We report our 23-year experience with leaflet and annular remodeling techniques in infants and children with congenital mitral valve insufficiency from lesions with restricted leaflet motion (type III). Methods: A review of the medical records, including follow-up echocardiographic studies of 49 children, aged 20 days to 14 years, was performed. These children were divided into age groups of 0 to <1 year (n = 4; mean age, 3.2 +/- 1.2 months), 1 to 5 years (n = 17; mean age, 2.8 +/- 1.6 years), and older than 5 to 15 years (n = 28; mean age, 12.3 +/- 2.5 years). All had severe mitral insufficiency from type III Carpentier's functional classification of mitral valve lesion. Restricted leaflet motion was secondary to commissural fusion in 17 children, thickened leaflets in 9, short chordae in 6, matted chordae in 2, papillary muscle hypoplasia in 3, a parachute valve in 11, and a hammock valve in 1. Various repair strategies were applied. Results: The perioperative course was unremarkable. The mean follow-up duration was 11.5 +/- 1.8 years. A 2-year-old patient with a parachute valve underwent mitral valve replacement 2 years after the initial repair. She died 8 years later of noncardiac causes. The freedom from reoperation rate was 100% at 30 days and 1 year and 97.9% at 5, 10, 15, and 20 years. The actuarial survival rate was 100% at 30 days, 1 year, and 5 years and 95.96% at 10, 15, and 20 years. Conclusions: Mitral valve reconstruction of congenital mitral insufficiency from restricted leaflet motion in infants and children using various modified repair techniques tailored to the presenting valve morphology can be successfully performed in children with excellent long-term results. (J Thorac Cardiovasc Surg 2012;143:S48-53)