Abstract
OBJECTIVE: For a cohort of patients with congenital mitral stenosis (CMS), to determine: patient outcomes, predictors of valve repairability and predictors of durability of valve repair. METHODS: From 1989 and 2002, 23 patients underwent surgical treatment of CMS, excluding those with common atrioventricular canal, and univentricular forms. The median age at operation was 15.5 months (range 2-204), and the median body weight was 11 Kg (range 4.5-51.6). Seventeen patients (73.9%) had associated anomalies, including Shone's complex in nine (39.1%) and pulmonary hypertension in 14 (60.9%). Mitral stenosis was severe in 14 patients (60.9%) and moderate in the remaining (median trans-mitral gradient of 16 mmHg, range 8.5-32). Mitral valve repair was performed in 18 patients (78.3%), and valve replacement in five (21.7%). Repair techniques included papillary muscle splitting (n=10), excision of supravalvular ring (n=9) and commissurotomy (n=8). Twelve patients (52.2%) required associated procedures. RESULTS: There were no early and late deaths at a mean follow-up of 58.5 ± 46.7 months (range 1-156). Mean hospital stay was 12.7 ± 8.2 days. There were no significant factors associated with unsuccessful valve repair. Actuarial freedom from reoperation at five years was 67.1% (CI 95%: 56.8% to 77.4%). The mitral valve repair group required reoperation in eight patients (44.4%) (two early and six late), as opposed to one (20%) in the replacement group. The presence of preoperative pulmonary hypertension was significantly related (p<0.005) to higher reoperation rates. All but two the followed patients are presently in functional class I and the echocardiography has shown less than 2+ mitral stenosis and/or regurgitation. CONCLUSION: Reoperations were the most important cause of morbidity at the medium-term follow-up of CMS. Preoperative pulmonary hypertension may predict the need for reoperation after mitral valve repair, which is the procedure of choice in CMS.
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