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Original Articles: Cardiovascular

Mitral Valve Repair for Infective Endocarditis in Children

^a Department of Cardiovascular and Thoracic Surgery, German Heart Center of Berlin, Berlin, Germany
^b Department of Congenital Heart Disease—Pediatric Cardiology, German Heart Center of Berlin, Berlin, Germany

Accepted for publication July 12, 2007.

^_* Address correspondence to Dr Delmo Walter, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin, 13353, Germany (Email: delmo-walter{at}dhzb.de).

Background: Surgery for mitral valve endocarditis in children is relatively uncommon. This study assesses its operative outcome and reoperation and long-term survival rates.

Methods: We reviewed the cases of 8 consecutive children who underwent mitral valve repair for infective endocarditis between 1989 and 2005 at our institution. Mean age was 13.8 years (range, 9.4 to 16.9 years). The mitral valve was affected in all 8 patients, and both aortic and mitral valve in 2. Congenital cardiac malformation was the predisposing factor in 3 patients. Three patients had floppy mitral valve owing to leaflet perforation. All 8 patients had severe mitral regurgitation. Indications for operations were cardiac failure in 2, septic embolization in 2, and severe mitral regurgitation in 4. Four surgical interventions were elective, two were urgent, and two were emergencies. The offending microorganism was identified in 7 of the 8 patients. Mitral valve repair or reconstruction was performed in all 8, and 2 patients had additional aortic valve replacement. Follow-up was complete (mean, 9.5 years; range, 0.67 to 16 years; total, 76.7 patient-years).

Results: There were no operative deaths. Actuarial freedom from reoperation and actuarial survival rate at 1, 5, 10, and 15 years were 100%. Early echocardiographic follow-up showed 4 patients to have mild mitral valve regurgitation, 2 had mild to moderate, and 2 had no regurgitation. Long-term follow-up showed no progression of the lesions.

Conclusions: Mitral valve repair achieves excellent results and can be performed without morbidity or mortality. Functional improvement and follow-up echocardiography evaluating the degree of mitral valve regurgitation and stenosis are satisfactory.

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