Congenital mitral valve defects in pediatric population: a narrative review of surgical repair

Abstract

Background and Objective: Congenital mitral valve malformations (CMVM) are rare and heterogeneous. The functional classification includes mitral regurgitation, stenosis, and combined lesions. Surgical strategies of CMVM remain challenging in the pediatric population due to various malformations, growth potential, the requirement of long-term anticoagulation, and the necessity of avoiding or delaying valve replacement. Surgical techniques for CMVM must be individually tailored for patients to achieve a proper valve function rather than “normal” anatomy. Compared with mitral repair, mitral valve replacement (MVR) is a less common procedure in children due to high mortality and morbidity rates. Options for cardiac valve replacement in children are limited to prostheses sizes that do not accommodate somatic growth, especially for neonates and infants. The need for lifelong anticoagulation may lead to adverse long-term pregnancy outcomes for female patients, limiting the application of MVR. This review aims to provide a comprehensive analysis of the current surgical techniques and developments for treating mitral valve (MV) regurgitation and stenosis and the outcome of various surgical strategies.