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Ann Thorac Surg 2008;85:2085-2088. doi:10.1016/j.athoracsur.2008.01.047
© 2008 The Society of Thoracic Surgeons
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Andrew N. Redington
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Glen S. Van Arsdell
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Original Articles: Pediatric Cardiac

Surgical Repair of the Mitral Valve in Children With Dilated Cardiomyopathy and Mitral Regurgitation

Mark A. Walsh, MDa,*, Lee N. Benson, MD, FRCPCa, Anne I. Dipchand, MDa, Andrew N. Redington, MDa, Christopher A. Caldarone, FRCSCb, Glen S. Van Arsdell, MD, FRCSCb, Paul F. Kantor, MBBCha

a Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
b Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada

Accepted for publication January 15, 2008.

* Address correspondence to Dr Walsh, Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada (Email: mark.walsh{at}sickkids.ca).

Background: Significant mitral regurgitation is known to exacerbate left ventricular dysfunction in dilated cardiomyopathy. Although intervention on the regurgitant mitral valve is frequently described in adults, there is little pediatric data.

Methods: Five children (aged 3 months to 4 years) with dilated cardiomyopathy and mitral regurgitation underwent mitral valve repair between January 1999 and January 2007 at our institution. All had mitral regurgitation graded as moderate to severe, with ejection fractions of 35% to 60% (median 53%).

Results: There were no deaths; all children were weaned from cardiopulmonary bypass; 1 child required cardiac transplantation 3 weeks after repair. After surgery, mitral regurgitation was moderate in 1 patient, mild in 2 patients, and trivial in 2 patients. The 4 successful cases showed an improvement in functional status at latest follow-up (range, 8 years to 4 months): all were asymptomatic (4 children had preoperative symptoms). Successful cases showed a decreased left atrial dimension (mean z-score 3.8 to 2.6) and a decreased left ventricular end-diastolic diameter (mean 6.9 ± 1.6 to 5.4 ± 1.2). Ejection fraction and left ventricular end-systolic index did not show an improvement and declined in some cases.

Conclusions: We conclude that repair of the mitral valve is feasible in children with dilated cardiomyopathy and acquired mitral regurgitation. Most of the children demonstrated decreased left ventricular chamber sizes and an improved functional status. Although this operation improves symptoms, it is not clear whether it postpones or abrogates the need for cardiac transplantation.


Related Article

Invited Commentary
Richard Mainwaring
Ann. Thorac. Surg. 2008 85: 2088-2089. [Extract] [Full Text] [PDF]



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R. Mainwaring
Invited commentary.
Ann. Thorac. Surg., June 1, 2008; 85(6): 2088 - 2089.
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