Cardiol Young 1994; 4:285-290 © World Publishers Limited ISSN 1047-9511 Reconstruction of the mitral valve in children—long-term follow-up in 63 cases Fause Attie, Carlos Zabal, Alejandro Juarez, Alfonso Buendia-Hernandez, Rodolfo Barragan, Juan Calder6n and Miguel Mini-Miranda From the Institute) National de Cardiologia "Ignacio Chdvez," Mexico Summary Between June 1985 and June 1991, 63 children underwent surgical reconstruction of the mitral valve for rheumatic (46 cases), congenital (12 cases) and myxoid (five cases) disease. The ages ranged from two to 18 years (mean 14.1 ±3.7 years). Valvar dysfunction was classified according to its pathophysiological abnormalities. A group of four cases presented with regurgitation secondary to lesions located in the valvar structures but with normal motion of the leaflets. In a second group of 14 cases, mitral regurgitation was due to prolapsed leaflets because of lesions located mainly in the subvalvar structures. A third group was formed by 35 patients with mitral regurgitation with restricted motion of the leaflets due to lesions in the valvar and subvalvar structures. The final group, of 10 cases, presented with mitral stenosis. The overall surgical mortality rate was 4.7% (3/63), and follow-up data were available in all survivors from one to 96 months (mean 33.4±25.4). Four cases underwent reoperation due to residual incompetence, one case due to bacterial endocarditis, and two more are scheduled for replacement of the valve due to unfavorable evolution, giving an overall rate of reoperation of 4.3% per patient/year. One patient died in the period following valvar replacement (late mortality rate of 0.6% per patient/year). Thromboembolism occurred in four cases in the absence of anticoagulation; three of them were in atrial fibrillation (late thromboembolic rate 2.4% per patient/ year). Prior to surgery, 28 cases were in functional class II of the New York Heart Association, 34 patients were in class III and one patient in class IV. At the end of the follow-up period, 49 patients were in class I, seven in class II and four in functional class III (p<0.0001). The cardiothoracic ratio before surgery ranged from 0.40 to 0.81 (mean 0.60±0.07) and, after surgery, the values ranged from 0.40 to 0.79 (mean 0.55±0.07) (p<0.0001). Randomized late echocardiographic evaluation in 24 cases revealed residual mild mitral regurgitation in 20 cases, moderate in two and severe in two. The latter are scheduled for valvar replacement. There were no significant differences in the surgical results among the four groups. Reconstruction of the mitral valve, therefore, provides stable functional results with low surgical and late mortality, as well as an acceptable rate of reoperation irrespective of the lesions of the valvar apparatus. Key words: Mitral valvar disease; cardiac surgery; surgical valvoplasty; rheumatic heart disease S INCE 1971, CARPENTIER AND HIS COLLEAGUES HAD periodically reported their experience with recon- struction of the mitral valve in patients with congenital or rheumatic disease. 1 " 4 The surgical tech- niques developed and used were designed to improve the function of the valve. They included ring Correspondence to Dr. Fause Attie, Instituto Nacional de Cardiologia "Ignacio Chdvez," Juan Badiano 1, Tlalpan, 14080 Mexico, D.F., M&ico. Tel. (5) 573- 2911; Fax. (5)573-0994. Accepted for publication 23 September 1993 annuloplasty, resection of tissues supporting the mural leaflet, division of fused and shortened cords, and cordal transposition. In the past, reconstruction was been undertaken by only a few surgeons, 5 ' 6 and the insertion of valvar prostheses, with their easy implantation and excellent immediate results, displaced for a while the generally less successful reconstructive techniques, with the exception of open commissurotomy. A wide variety of prosthetic valves have been evaluated over the past three decades, and many have been shown to demon-