This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Serraf, A. Articles by Planché, C. Search for Related Content PubMed PubMed Citation Articles by Serraf, A. Articles by Planché, C. Related Collections CV surgery: valvular disease Pediatric and congenital heart disease, including cardiovascular surgery

(Circulation. 2000;102:III-166.)
© 2000 American Heart Association, Inc.

Surgery for Congenital Heart Disease

Congenital Mitral Stenosis With or Without Associated Defects

An Evolving Surgical Strategy

Alain Serraf, MD; Joy Zoghbi, MD; Emré Belli, MD; François Lacour-Gayet, MD; Hakim Aznag, MD; Lucile Houyel, MD; Virginie Lambert, MD; Dominique Piot, MD; Claude Planché, MD

From the Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Le Plessis-Robinson, France. Correspondence to A. Serraf, MD, Marie-Lannelongue Hospital, 133 Ave de la Résistance, 92350 Le Plessis-Robinson, France.

Background—Congenital mitral stenosis (CMS) remains a surgical challenge, particularly when it is associated with other heart defects. As in other groups of heart defects, there is a trend toward early single-stage complete repair, but the optimal surgical approach remains unanswered.

Methods and Results—This study was designed to analyze the evolution of surgical strategies in patients with CMS and associated defects through single-stage and staged repair. Between 1980 and 1999, 72 children were operated on for congenital heart defects, including CMS. Preoperative transmitral gradient was 12.6±7 mm Hg. Preoperatively, all the patients were NYHA class III to IV. Thirteen patients had an isolated CMS; in 59, it was associated with other heart defects, mainly ventricular septal defect (n=28) or multilevel left ventricular obstruction (n=41). In this group of patients, 33 had a staged approach, and 26 had a single-stage approach. Early mortality was 12.5% (9 patients). There were no deaths in the isolated CMS and single-stage repair groups. Logistic regression revealed that early mortality was influenced by association with left ventricular outflow tract obstruction (P<0.001) and by use of a staged approach (P<0.01). There was no late mortality in isolated CMS; there were 2 late deaths in the group of single-stage repair and 6 late deaths in the staged approach group (P<0.01). Reoperation was required in 24 patients, mainly for residual mitral valve dysfunction or residual left ventricular outflow tract obstruction. Including the reoperations, 10 patients received a prosthetic mitral valve. At 15 years after surgery, survival was 69.6±7.5%, freedom from reoperation was 70.8±6.3%, and freedom from mitral valve replacement was 69±6%.

Conclusions—Surgery for isolated CMS gives excellent early and long-term results. In patients with associated heart defects, a single-stage operation seems superior to a staged approach. Mitral valve replacement in this category of patients should be reserved as a salvage procedure.

Key Words: mitral valve • stenosis • surgery • pediatrics

This article has been cited by other articles:

				D. D. Bell, P. G. Brindley, D. Forrest, O. A. Muslim, and D. Zygun Management following resuscitation from cardiac arrest: recommendations from the 2003 Rocky Mountain Critical Care Conference: [Conduite a tenir apres la reanimation post-arret cardiaque : recommendations de la conference du Rocky Mountain Critical Care 2003] Can J Anesth, March 1, 2005; 52(3): 309 - 322. [Abstract] [Full Text] [PDF]