Article

The Efficacy of Mitral Valve Surgery in Children with Dilated Cardiomyopathy and Severe Mitral Regurgitation

Baylor College of Medicine 6621 Fannin Street MC19345 Houston TX 77030 USA
Pediatric Cardiology (impact factor: 1.3). 04/2012; 29(1):13-18. DOI:10.1007/s00246-007-9050-x

ABSTRACT Severe mitral regurgitation predicts poor outcomes in adults with left ventricular dysfunction. Frequently, adult patients
now undergo initial mitral valve surgery instead of heart transplant. Pediatric data are limited. This study evaluates the
efficacy of mitral valve surgery for severe mitral regurgitation in children with dilated cardiomyopathy. This is a single-institution
experience in seven children (range, 0.5–10.9 years) with severe mitral regurgitation and dilated cardiomyopathy who underwent
mitral valve surgery between January 1988 and February 2005, with follow-up to January 2006. Children with dilated cardiomyopathy
had a depressed fractional shortening preoperatively (24.4% ± 6.1%) that remained depressed (22.9% ± 7.6%) 1.3 ± 1.2 years
after surgery (p = 0.50). Left ventricular end-diastolic (6.5 ± 1.5 to 4.8 ± 1.8 z-scores, p < 0.01) and end-systolic (6.8 ± 1.5 to 5.5 ± 2.1 z-scores, p < 0.05) dimensions improved. Hospitalization frequency had a median decrease of 6.0 hospitalizations per year (p < 0.02). Three patients were transplanted 0.2, 2.4, and 3.5 years after surgery. There was no perioperative mortality. Mitral
valve surgery in children with dilated cardiomyopathy was performed safely and improved symptoms, stabilizing ventricular
dysfunction in most patients. Mitral valve surgery should be considered prior to heart transplant in children with dilated
cardiomyopathy and severe mitral regurgitation.

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Keywords

6.0 hospitalizations
 
adult patients
 
adults
 
children
 
depressed fractional
 
dilated cardiomyopathy
 
end-systolic
 
heart transplant
 
Hospitalization frequency
 
initial mitral valve surgery
 
median decrease
 
Mitral valve surgery
 
Pediatric data
 
perioperative mortality
 
poor outcomes
 
remained depressed
 
Severe mitral regurgitation
 
symptoms
 
ventricular dysfunction