To explore the clinical efficacy and follow-up results of the valve-in-valve transcatheter mitral valve replacement (TMVR) technique in patients with mitral bioprosthetic valve dysfunction. The medical data of patients with biological valve dysfunction after mitral valve replacement who underwent TMVR in our hospital from January 2019 to January 2024 were retrospectively collected. The echocardiography data, New York Heart Association (NYHA) grade, EuroQol visual analogue scale (EQ-VAS) score, and 6-minute walking distance before and after the operation were compared. A total of 33 patients, 8 males and 25 females, with an average age of 70.70 ± 9.04 years, were included in this study. All 33 patients underwent TMVR surgery successfully. Seven patients underwent surgery via the atrial septal approach, and 26 patients underwent surgery via the apical approach. The success rate of the TMVR was 100.0%. One patient had a complication of cerebral infarction and eventually died 7 days after the operation. Compared with those prior to the operation, the NYHA grade, EQ-VAS score and the 6-minute walking distance were improved significantly at follow-up (all P < 0.05). Valve-in-valve TMVR is a feasible option for patients with degenerated bioprosthetic mitral valves. However, follow-up studies are still needed to determine the long-term effects.

Concomitant Mitral Valve Surgery During Surgical Treatment of Hypertrophic Obstructive Cardiomyopathy.

Bioprosthetic mitral valves are prone to structural valve deterioration (SVD) over time, which can lead to bioprosthetic valve dysfunction (BVD) requiring reintervention. Surgical redo-mitral valve replacement (rMVR) is currently the standard treatment, although it is associated with significant mortality in high-risk patients. Transcatheter mitral valve-in-valve (mViV) has emerged as an alternative to surgical rMVR in patients with failed bioprostheses, but randomised studies comparing the two treatments are lacking. The SURVIV trial is an investigator-initiated, prospective, multicentre, open-label, randomised controlled trial that will enrol 150 patients with mitral BVD suitable for surgical rMVR or transcatheter mViV. Participants will be randomised 1:1 to transseptal mViV with a balloon-expandable transcatheter heart valve or to conventional surgical rMVR. Procedures will be performed according to local best practices with contemporary medical devices. The primary endpoint is the composite of all-cause mortality or disabling stroke at 12 months. Key secondary endpoints are major complications (cardiovascular death, disabling stroke, life-threatening or major bleeding, acute kidney injury stage 2 or 3, and major vascular complications) at 30 days, according to Mitral Valve Academic Research Consortium criteria; rehospitalisation for cardiovascular causes at 12 months; echocardiographic and/or tomographic signs of prosthetic valve thrombosis and early SVD at 3 and 12 months; and health-related quality of life (EQ-5D-5L) at 3 and 12 months. Clinical follow-up will continue up to 10 years. SURVIV is the first randomised trial to compare a transcatheter mViV procedure with surgical rMVR for mitral BVD and may provide further clinical evidence to guide the management of patients with failed mitral bioprostheses. ClinicalTrials.gov: NCT04402931.

Valve function during graft rejection and before graft failure in pediatric heart transplant recipients.

Mitral annular calcification (MAC) is a progressive, degenerative process increasingly recognised for its clinical impact. Beyond being an incidental finding, MAC contributes to mitral valve dysfunction, arrhythmias, systemic embolisation and elevated cardiovascular risk. In developed countries, it has now overtaken rheumatic disease as the leading cause of mitral stenosis.The pathophysiology of MAC involves chronic mechanical stress, pro-inflammatory activation and osteogenic differentiation of valvular cells. Progression is accelerated by age, chronic kidney disease and metabolic derangements. Diagnosing MAC-related valve dysfunction is challenging, as traditional echocardiographic measures often prove unreliable. Multimodality imaging-including 3D echocardiography and cardiac CT-is essential for assessing anatomy, function and procedural feasibility. Importantly, symptoms often reflect combined valvular (eg, aortic stenosis) and myocardial disease (eg, heart failure with preserved ejection fraction (HFpEF) phenocopy), necessitating careful haemodynamic evaluation to avoid futile interventions.Management should prioritise medical therapy for symptom control and comorbid HFpEF, reserving interventions for selected patients. Surgical and transcatheter approaches carry high risk and should be undertaken only in specialised centres. Future advances may include tailored devices and therapies targeting calcification pathways.

Mitral annulus calcification (MAC) is a chronic, degenerative process characterized by calcium deposition in the mitral annulus. It is commonly observed in elderly individuals and those with chronic kidney disease, hypertension, and metabolic disorders. MAC has been increasingly recognized as a marker of cardiovascular disease and is associated with adverse clinical outcomes, including mitral valve dysfunction, arrhythmias, and increased cardiovascular mortality. The pathophysiology of MAC involves endothelial dysfunction, chronic inflammation, and osteogenic differentiation of valvular interstitial cells, driven by risk factors such as aging, chronic kidney disease, diabetes mellitus, and hypertension. Imaging modalities, including echocardiography and computed tomography (CT) play a crucial role in the diagnosis, assessment, and risk stratification of MAC. The presence of MAC complicates mitral valve interventions, making surgical and transcatheter approaches challenging. Despite advancements in imaging and therapeutic strategies, MAC remains a significant challenge in cardiovascular medicine, necessitating further research into its pathophysiology, optimal management strategies, and long-term outcomes.

Patient: Female, 70-year-oldFinal Diagnosis: Atypical hemolytic uremic syndrome triggered by artificial mitral valve dysfunctionSymptoms: Anemia • crepitations • dyspnea • hematuria • malaise • muffled breath sounds • numerous schistocytes in the blood smear • recurrent episodes of bleeding from oral mucosa • significant edema of lower extremities • thrombocytopeniaClinical Procedure: —Specialty: NephrologyObjective: Rare diseaseBackgroundHemolytic uremic syndrome (HUS) is a severe disease classified under thrombotic microangiopathies and characterized by acute kidney injury, microangiopathic hemolytic anemia, and thrombocytopenia. HUS can be divided into 2 subtypes: typical HUS and atypical HUS (aHUS). The standard treatment for aHUS, a complement-mediated thrombotic microangiopathy, as approved in the United States and European Union involves long-term administration of eculizumab or ravulizumab with complement-mediated thrombotic microangiopathy. This report is of a 70-year-old woman with aHUS triggered by artificial mitral valve dysfunction.Case ReportA 70-year-old woman with history of artificial mitral valve replacement was admitted to the nephrology department with suspected HUS. She presented with malaise, dyspnea, anemia, thrombocytopenia, hemolysis, and schistocytes in blood smear. Complement factors were normal, but sC5b-9 was elevated, suggesting complement overactivation. ADAMTS-13 was >10%, ruling out thrombotic thrombocytopenic purpura. Infection with a Shiga toxin–producing bacterium was ruled out. Genetic tests for complement factors revealed no pathogenic variants. The patient was treated with eculizumab, leading to significant clinical improvement. Due to her cardiac history, a comprehensive cardiologic evaluation was performed, revealing perivalvular leakage and severe dysfunction of the mitral valve prosthesis. She subsequently underwent a 2-step intravascular mitral valve repair. The administration of eculizumab resulted in clear improvement in hemolysis, renal function, and platelet count prior to mitral valve surgery, strongly supporting the diagnosis of an aHUS-type thrombotic microangiopathy. Surgical intervention was subsequently performed and contributed to long-term stabilization.ConclusionsThis case underscores the challenges of treating thrombotic microangiopathy in a patient with multiple comorbidities and complicated medical history.

BackgroundMitral annular calcification (MAC) is a degenerative calcific pathology of the mitral valve (MV) associated with MV dysfunction and poor patient outcomes. The pathophysiologic complexity of MAC presents unique challenges for surgical management. In this systematic review, we summarize the heterogenous approaches to MV surgery for MAC and assess early and late outcomes of each approach.MethodsA systematic literature search was performed in the PubMed, EMBASE, and Web of Science databases. Three reviewers independently selected relevant studies through a sequential three-step review process. Based on included descriptions of intraoperative methods, each study was categorized as either a “MAC Respect” or “MAC Resect” intervention. Quantitative data were collected, aggregated across all studies, and analyzed by surgical approach.ResultsOur initial search yielded 635 unique studies, of which 19 studies met inclusion criteria for quantitative data extraction. Based on the operative approach, two cohorts of “MAC Respect” (N=550) and “MAC Resect” (N=487) were created. Baseline characteristics were similar; the median patient age and proportion of female patients were 71.5 years and 66.4% in the “Respect” group and 70.3 years and 54.9% in the “Resect” group, respectively. A median of 26.9% of patients in the “Resect” group and 12.5% in the “Resect” group were classified as New York Heart Association (NYHA) class III or IV. “Respect” studies had a median cardiopulmonary bypass time of 156 minutes, while “Resect” studies had a median time of 181.5 minutes. The median intensive care unit stay was two days for the “Respect” group and 3.5 days for the “Resect” group. Ranges of complication rates largely overlapped between groups. Thirty-day, one-year, and long-term mortality rates were 0–25%, 0–44%, and 0–27% in the “Respect” group and 0–14%, 0–18%, and 0–50% in the “Resect” group.ConclusionsSurgical intervention remains the gold-standard for management of MAC-related MV dysfunction; however, there is no standardized consensus for the optimal surgical approach. This systematic review evaluates the advantages, disadvantages, and outcomes of several approaches to MAC surgical intervention. Our findings underscore the heterogeneous presentation of MAC and the associated complications to avoid in order to improve patient outcomes.

We report association of indices of cardiac remodeling and fibrosis on magnetic resonance imaging (MRI) with atrial fibrillation (AF) in patients with moderate to severe rheumatic mitral valve disease. Sixty consecutive patients of RHD with moderate to severe mitral valve dysfunction: 30 with atrial fibrillation and 30 age and sex matched without atrial fibrillation were enrolled as cases and controls respectively. The left atrial (LA) volume, left ventricular (LV) volumes and ejection fraction were calculated using MRI. The association of clinical and MRI parameters with atrial fibrillation was estimated by calculating Odds ratio with 95% C.I. using multivariate logistic regression model. The LA volume (211.23 ± 45.50ml vs. 129.7 ± 45.8 ml; p < 0.005) was significantly higher in patients with atrial fibrillation. The LVEF (46.8 ± 10.2% vs. 55.9 ± 15.0%; p < 0.008) and RVEF (39.9 ± 9.4% vs. 46.8 ± 14.2%; p < 0.03) were significantly lower in patients with atrial fibrillation. The LA fibrosis was significantly higher in patients with atrial fibrillation (93.34% vs. 26.67% p < 0.001). Age, LA volume, LV and RV ejection fraction had no significant association after adjustment of effect of LA fibrosis. LA fibrosis had significant and independent association with atrial fibrillation (Odds ratio 25.9, 95% C.I. 4.2, 158.3; p < 0.001). LA fibrosis was the lone risk factor associated with atrial fibrillation in patients with RHD with moderate to severe mitral valve dysfunction. Role of LA fibrosis in prediction of atrial fibrillation may have potential role in risk stratification in patients with normal sinus rhythm.

Transcatheter Mitral Valve Replacement for Severe Mitral Annular Calcification: Primary Outcomes From the SUMMIT-MAC Study.

Due to the high mortality and morbidity of patients with aortic and mitral endocarditis, careful monitoring is necessary to recognize an early failure of antibiotic and cardiokinetic therapy and avoid a possible cardiogenic or septic shock. The timing of surgery is crucial for patients in whom medical therapy fails. The aim of our study is to identify potential echocardiographic biomarkers of adverse events in patients with left-sided native valve infective endocarditis. Sixty-four patients with aortic and/or mitral valve dysfunction(AOVD, MVD) from infective endocarditis were studied by three-dimensional transesophageal echocardiography(3DTEE) and transthoracic speckle tracking echocardiography(3DSTE). Sixty-four healthy subjects were selected as controls. Vegetation size and valvular features were assessed by 3DTEE. Standard transthoracic echocardiographic parameters were determined. Global left ventricular(LV) longitudinal strain(3D-LVGLS) and area strain(3D-LVGAS) were measured by 3DSTE. Averaged LV rotation and rotational velocities from the base and apex were obtained and used for calculation of LV twist and torsion. Endpoints were embolism and in-hospital mortality. Maximal vegetation dimension was 10(4-29) mm if measured by 3DTEE and 7(4-20) mm if measured by 2DTEE (p = 0.02). Valvular and perivalvular complications were present in 21(33%) and 13(20%) patients. AOVD/MVD patients had decreased GLS (p = 0.011), GAS (p = 0.003) and LVtwist (p = 0.024) compared with control subjects. By multivariate analysis, vegetation mobility(p = 0.001), vegetation size(p = 0.003), perivalvular complications(p = 0.006), and bivalvular vegetations(p = 0.009) were independent predictors of embolic events. Valve-related complications(p = 0.001), vegetation size(p = 0.029), 3D-LVGLS(p = 0.013), and 3D-LVGAS(p = 0.002) were predictive of in-hospital mortality. Using a composite endpoint of both outcomes, ROC curves suggested that 3D valvular and LV function parameters had higher diagnostic accuracy for identifying adverse events than 2D parameters. 3D combined evaluation of vegetation size, regurgitant volume and LV area strain had the highest diagnostic accuracy (AUC 0.89, p = 0.001). Significant improvement in global χ2 value was noted with 3D strain parameters compared with LV ejection fraction for predicting outcome (from 82.3 to 90.5, p = 0.004). 3D combined assessment of anatomical-functional valve characteristics and LV function strain parameters improves the sensitivity of the echocardiographic indices in predicting cardiac morbidity and mortality of left-sided native valve infective endocarditis.

Mitral annular disjunction (MAD) is a structural abnormality characterized by the separation of the mitral valve annulus from the left ventricular myocardium, often in association with mitral valve prolapse (MVP). Initially identified in the 1980s, MAD was not considered clinically significant at the time. However, recent advancements in imaging techniques have renewed interest in its potential role in mitral valve dysfunction and arrhythmias. Several studies have suggested a possible association with arrhythmogenic events, including non-sustained ventricular tachycardia. Nonetheless, its independent role in arrhythmogenesis remains a subject of debate. Advanced imaging techniques, particularly cardiac magnetic resonance (CMR), have proven valuable for diagnosing MAD and evaluating its implications, especially by detecting myocardial fibrosis. This review aims to provide a comprehensive overview of the current literature on MAD, with a focus on its diagnosis, clinical significance, and the application of advanced imaging modalities such as cardiac computed tomography (CCT) and CMR.

Patients with end-stage renal disease are at increased risk for developing mitral valve calcification and dysfunction. The present study evaluated clinical and financial outcomes of transcatheter compared with surgical mitral valve replacement/repair in patients with end-stage renal disease using a national cohort. This was a retrospective analysis of all adult patients with end-stage renal disease receiving isolated surgical mitral valve replacement/repair or transcatheter mitral valve replacement/repair in the Nationwide Readmissions Database (2016-2021). Outcomes included in-hospital mortality, 30-day nonelective readmissions, complications, hospitalization costs, length of stay, and nonhome discharge. Entropy balancing and multivariable regressions adjusted for intergroup differences, with results reported as adjusted odds ratios and 95% confidence intervals. Among 3,782 patients with end-stage renal disease, 12.8% underwent transcatheter mitral valve replacement/repair, with use significantly increasing from 49 cases in 2016 to 122 cases in 2021 (NPTrend < 0.001). Patients undergoing transcatheter mitral valve replacement/repair were older (70 vs 58 years, P < .001) and had greater rates of atrial fibrillation (57.8 vs 46.8%, P < .001) and mitral stenosis (21.7 vs 8.6%, P < .001). After entropy balancing and risk adjustment (with surgical mitral valve replacement/repair as reference), transcatheter mitral valve replacement/repair did not alter the odds of in-hospital mortality (adjusted odds ratio, 1.70; confidence interval, 0.96-2.99), 30-day readmissions (adjusted odds ratio, 0.99; confidence interval, 0.62-1.59), or hospitalization costs (β -$4.4K, confidence interval, -$20.3K to $11.6K). Transcatheter mitral valve replacement/repair was associated with reduced odds of blood transfusion (adjusted odds ratio, 0.45; confidence interval, 0.29-0.72), infectious (adjusted odds ratio; 0.53, confidence interval, 0.32-0.88) and respiratory (adjusted odds ratio, 0.34; confidence interval, 0.24-0.47) complications, and non-home discharge (adjusted odds ratio; 0.29, confidence interval, 0.17-0.50). In conclusion, our study underscores the evolving landscape of mitral valve interventions, highlighting the complementary roles of surgical mitral valve replacement/repair and transcatheter mitral valve replacement/repair. The increasing adoption of transcatheter mitral valve replacement/repair reflects its favorable safety profile and improved discharge outcomes, particularly in elderly and high-risk patients. Future research should focus on further evaluating long-term outcomes and exploring strategies to enhance the cost-effectiveness and accessibility of both interventions.

Bioprosthetic mitral valve replacement is being increasingly performed in the context of an aging population and the exponential growth of minimally invasive surgical and transcatheter interventions. As with all bioprosthetic valves, dysfunction remains a significant challenge that can manifest as structural or non-structural modes of degeneration and necessitates close follow-up with timely re-intervention as necessary. In this primer article, we highlight approaches on evaluating and treating bioprosthetic mitral valve dysfunction, including the role of transcatheter mitral valve-in-valve implantation.

Introduction: Mitral valve transcatheter edge-to-edge repair (M-TEER) has emerged as a minimally invasive option for high-risk surgical candidates with severe and symptomatic mitral regurgitation (MR), but post-procedure residual mitral valve (MV) dysfunction remains a significant concern. This study evaluates the clinical utility of combining artificial intelligence applied to electrocardiograms (ECG-AI) for diastolic dysfunction (DD) grading and the echocardiography-derived velocity time integral of the MV and left ventricular outflow tract ratio (VTIMV/LVOT) in predicting prognosis in patients post-M-TEER. Methods: A retrospective analysis of patients who underwent M-TEER between 2014 and 2021 was conducted. Patients were categorized based on VTIMV/LVOT and ECG-AI scores into three groups: both normal parameters, either abnormal parameter, or both abnormal parameters to compare outcomes (mortality, major adverse cardiovascular events [MACE], and the need for subsequent MV reintervention) using Kaplan-Meier analysis, multivariable Cox regression models, and net reclassification improvement. Results: Overall, 250 patients were included; the median age was 79.5 (IQR: 73.1, 84.6) and 66.4% were male. The combined abnormal VTIMV/LVOT (≥2.5) and ECG-AI score for DD (>1) was associated with higher risk of one-year mortality (adjusted HR: 4.56 [1.04-19.89], p = 0.044) and MACE (adjusted HR: 3.72 [1.09-12.72], p = 0.037) compared to patients with both normal parameters. Conclusions: This study highlights the potential additive value of integrating VTIMV/LVOT and ECG-AI scores as a prognostic tool for a personalized approach to the post-operative evaluation and risk stratification in M-TEER patients.

Mitral annular calcification (MAC) is common in patients with severe aortic stenosis (AS); however, the impact of its severity and associated mitral valve dysfunction (MVD) on patient outcomes remains unclear. This study aims to assess the influence of MAC severity and MVD on outcomes in individuals with severe AS. This retrospective study included 613 patients with severe AS. Patients were categorized by echocardiographic MAC severity and the presence of MVD, defined as a mean transmitral gradient (mTMG) ≥ 5 mmHg. In total, 309 (50.4%) of the 613 patients had MAC (44% mild, 40% moderate, and 16% severe), and 21% also displayed MVD. Patients with MAC had a lower 6-year survival (47 ± 3% vs. 64 ± 3%, log-rank P < 0.001) even after adjustment for covariates with prognostic impact {hazard ratio [HR] [95% confidence interval (CI)] = 1.24 [1.03-1.67]}. Severe MAC was associated with being older, being female, higher comorbidity scores, and high pulmonary pressures (all P < 0.05) and with a lower 6-year survival (23 ± 7%) than mild (55 ± 5%) or moderate MAC (50 ± 5%). Patients with both MAC and MVD had a 6-year survival of 28 ± 7%, markedly lower than the 53 ± 4% for those with MAC but not MVD. Multivariable analysis indicated that severe MAC [HR (95% CI) = 2.63 (.51-4.60)] and MVD [HR (95% CI) = 1.86 (1.24-2.77)] were independent predictors of death. MAC is highly prevalent in patients with severe AS, affecting more than 50%. It is associated with shorter survival, particularly if MAC is severe or the patient also has MVD. These findings highlight the importance of evaluating MAC severity and mTMG in AS patients to guide clinical decisions.

Background: Coronary heart disease (CHD) remains the most prevalent pathology within the circulatory system. Among its chronic complications, ischemic mitral valve regurgitation (IMR) is observed in approximately 15% of patients with sustained myocardial ischemia. The presence of this complex valvular defect significantly increases both overall mortality and the incidence of adverse cardiovascular events. Notably, the presence of moderate to severe mitral regurgitation in patients undergoing surgical revascularization has been shown to double the risk of death. Despite the well-established etiology of IMR, data regarding the efficacy of surgical interventions and the determinants of postoperative outcomes remain inconclusive. Methods: The objective of the present study was to evaluate both early and long-term outcomes of surgical treatment of mitral regurgitation in patients undergoing coronary artery bypass grafting (CABG) due to ischemic heart disease. Particular attention was given to the influence of the severity of regurgitation, left ventricular ejection fraction (LVEF), and the dimensions of the left atrium (LA) and left ventricle (LV) on the postoperative prognosis. An additional aim was to identify preoperative risk factors associated with increased postoperative mortality and morbidity. A retrospective analysis was conducted on 421 patients diagnosed with ischemic mitral regurgitation who underwent concomitant mitral valve surgery and CABG. Exclusion criteria included emergent and urgent procedures as well as non-ischemic etiologies of mitral valve dysfunction. Results: The study cohort comprised 34.9% women and 65.1% men, with the mean age of 65.7 years (±7.57). A substantial proportion (76.7%) of patients were aged over 60 years. More than half (51.5%) presented with severe heart failure symptoms, classified as NYHA class III or IV, while over 70% were categorized as CCS class II or III. Among the surgical procedures performed, 344 patients underwent mitral valve repair, and 77 patients required mitral valve replacement. Additionally, 119 individuals underwent concomitant tricuspid valve repair. Short-term survival was significantly affected by the presence of hypertension, prior cerebrovascular events, and chronic kidney disease. In contrast, hypertension and chronic obstructive pulmonary disease were identified as significant predictors of adverse late-term outcomes. Conclusions: Interestingly, neither the preoperative severity of mitral regurgitation nor the echocardiographic measurements of LA and LV dimensions were found to significantly influence surgical outcomes. The perioperative risk, as assessed by the EuroSCORE II (average score: 10.0%), corresponded closely with observed mortality rates following mitral valve repair (9.9%) and replacement (10.4%). Notably, the need for concomitant tricuspid valve surgery was associated with an elevated mortality rate (12.4%). Furthermore, the preoperative echocardiographic evaluation of LA regurgitation severity, as well as LA and LV dimensions, did not exhibit a statistically significant impact on either early or long-term surgical outcomes. However, a reduced LVEF was correlated with increased long-term mortality. The presence of advanced clinical symptoms and the necessity for tricuspid valve repair were independently associated with a poorer late-term prognosis. Importantly, the annual mortality rate observed in the late-term follow-up of patients who underwent surgical treatment of ischemic mitral regurgitation was lower than rates reported in the literature for patients managed conservatively. The EuroSCORE II scale proved to be a reliable and precise tool in predicting surgical risk and outcomes in this patient population.

BackgroundMitral annular calcification (MAC) is a chronic and progressive degenerative process characterized by calcium and lipid deposition of the mitral valve annulus. We sought to describe the natural history of patients with MAC with and without mitral valve dysfunction (MVD).MethodsWe conducted an observational study of patients with an echocardiogram-based diagnosis of MAC from 2006-2023. Patients were matched by age and sex in a 1:1 ratio to patients without MAC. We collected baseline clinical, echocardiographic, and computed tomography data. The primary end point was all-cause mortality. We also report predictors of mortality in patients with MAC and MVD.ResultsWe included 15,372 patients in the analysis: 7686 with MAC (median age, 76 years [68-84], 58% women) and 7686 without MAC matched by age and sex. Patients with MAC had higher rates of comorbidities, cardiovascular risk factors, MVD, and multivalvular heart disease (aortic stenosis/regurgitation and tricuspid regurgitation) relative to patients without MAC (all P < .001). Two-year mortality was 14%, 26%, and 21% for patients with MAC and no MVD, MAC with ≥moderate MR, and MAC with ≥moderate MS, respectively (P < .001). Surgical or transcatheter mitral valve interventions in patients with MAC and significant MVD were infrequently performed (n = 136/788, 17.2%).ConclusionsTen percent of patients with MAC have clinically significant MVD, with mitral regurgitation being more common than mitral stenosis. The presence of MVD is associated with significantly increased mortality in patients with MAC.

Isolated congenital mitral pathology occurs with a frequency of 0.5% among all congenital heart defects and is combined with others in 65–82% of cases. Surgical treatment of congenital mitral valve dysfunction still results in a significant mortality rate. In the presence of severe mitral valve pathology and the impossibility of performing valve repair in children of all ages, valve replacement becomes vitally necessary. The goal of mitral valve repair is not only to restore anatomy but, more importantly, to restore functional hemodynamics. Аim. To analyze the perioperative characteristics of patients and the immediate and long-term results of surgical correction of the mitral valve in pediatric patients. Materials and methods. Between 2014 and 2024, 135 patients aged 2 months to 18 years with congenital mitral valve anomalies underwent surgical correction (mitral valve repair or replacement) at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. There were 64 male patients (47.4 %) and 71 female patients (52.6 %). The most common congenital heart defects associated with mitral valve anomalies in the study group were: atrioventricular septal defect – 61 cases (45.2 %), hypertrophic cardiomyopathy – 24 (17.8 %), congenital isolated mitral valve disease – 15 (11.1 %), and infective endocarditis of the mitral valve – 10 (7.4 %). Results and discussion. In the early postoperative period, 4 patients died, resulting in a hospital mortality rate of 3.0 %. In 3 patients (2.2 %), the cause of death was acute heart failure, while in 1 patient (0.7 %) it was respiratory failure due to viral pneumonia. During long-term follow-up, there was one additional death (0.7 %).Mitral valve replacement was required in 6 patients (4.4 %). The mean follow-up duration was 49 ± 16.2 months. Severe residual mitral regurgitation occurred in 4 patients (2.3 %), necessitating reintervention. Moderate mitral regurgitation was observed in 22 patients (17 %), mild in 27 patients (20 %), and minimal in 32 patients (23.7 %). No recurrences were recorded among patients with infective endocarditis during the follow-up period. All patients with associated intracardiac anomalies underwent concomitant surgical correction. Conclusions. Modern diagnostic techniques enable the early detection of mitral valve anomalies, and contemporary surgical approaches yield favorable outcomes. Mitral valve repair is intended not only to reconstruct anatomical integrity but, more critically, to restore physiological hemodynamic performance. The 10-year reoperation-free rate of 97.1 % highlights the durability of surgical interventions. Reconstructive surgery remains the treatment of choice in pediatric patients, as it is associated with a lower risk of complications compared to valve replacement.

Mitral annular calcification in severe aortic stenosis: Prognostic value of calcification severity and Mitral valve dysfunction