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Surgical treatment of congenital mitral valvar stenosis: “The Hôpital Broussais” experience

Published online by Cambridge University Press:  19 August 2008

Sylvain M. Chauvaud ,
Serban A. Milhaileanu ,
Julian A. R. Gaer  and
Alain C. Carpentier
Sylvain M. Chauvaud*
Affiliation:
Department of Cardiovascular Surgery, Hôpital BroussaisFrance
Serban A. Milhaileanu
Affiliation:
Department of Cardiovascular Surgery, Hôpital BroussaisFrance
Julian A. R. Gaer
Affiliation:
Department of Cardiovascular Surgery, Hôpital BroussaisFrance
Alain C. Carpentier
Affiliation:
Department of Cardiovascular Surgery, Hôpital BroussaisFrance
*
S Chauvaud, Hôpital Broussais, Service de Chirurgie Cardiovasculaire, 96 rue Didot, 75014 Paris, France. Tel: 33 1 43 95 93 42, Fax: 33 1 43 95 93 42
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Abstract

Lesions producing congenital mitral valvar stenosis are complex and often multiple, From 1970 to 1994, 58 patients under 12 years of age (mean 5 ± 3.2 y) underwent surgical treatment for such malformations in our department. In order to provide a clear understanding of the pathology, we used a classification based on anatomy and function. Echocardiography was a major tool of the preoperative investigations. The lesions were classified as follows:

Normal papillary muscles: commissural fusion in 19, excess leaflet tissue in 2, valvar ring in 12, and annular hypolasia in 2.

Abnormal papillary muscles: paachute arrangement in 10 and hammock mitral valve in 13.

Associated malformations were found in 63%, the most common being multiple stenosis in the left heart. Conservative treatment was possible in 54 patients (95%) using the techniques developed by Carpentier. Hospital mortality was 22%, with 95% confident limits between 13 and 36% (13/58). Of the 13 patients with a hammock valve, 6 died in hospital. The overall mean period of follow up was 7.8 + 5 years. No thromboembolic events occured after conservative surgery. Late death occured in 3%. The actuarial survival at 5 years was 64 + 15%. Reoperation was needed for residual mitral valvar stenosis in three patients or insufficiency in one.

In spite of effective techniques to relieve mitral obstruction, 12% of our patients need early or delayed replacement of the valve. The hospital mortality remains high due to the complexity of the lesions, associated with the associated malformations. Echocardiography proved to be extremly helpful for the functional analysis. In order to improve operative results, simple and early valvar repair, even if considered palliative, seems to be appropriate.

Keywords

Congenital mitral valvar stenosisconservative valvar surgery
Type
Review Article
Information
Cardiology in the Young , Volume 7 , Issue 1 , January 1997 , pp. 15 - 21
Copyright
Copyright © Cambridge University Press 1997

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References

1.Chauvaud, SM, Mihaileanu, SA, Gaer, JAR, Carpentier, AC. Surgical treatment of Ebstein's malformation the “Hopital Broussais” experience. Cardiol Young 1996; 6: 4–11.CrossRefGoogle Scholar
2.Chauvaud, SM, Mihaileanu, SA, Gaer, JAR, Carpentier, AC. Surgical congenital mitral insufficiency: the “Hopital Broussais” experience. Cardiol Young, 1997 7 (1): 6–15.Google Scholar
3.Daoud, F, Kaplan, S, Perrin, EV, Dorst, JP, Edwards, FK. Congenital mitral stenosis. Circulation, 1963; 27: 185–191.CrossRefGoogle ScholarPubMed
4.Ruckman, RN, Van Praagh, R. Anatomic types of congenital mitral valve stenosis: report of 49 autopsy cases with consideration of diagnosis and surgical implications. Am J Cardiol 1978; 42: 592–601.CrossRefGoogle ScholarPubMed
5.Van Der Horst, RL, Hastreiter, AR. Congenital mitral stenosis. Am J Cardiol 1967; 20: 773–776.CrossRefGoogle ScholarPubMed
6.Edwards, JE, Carey, LS, Neufeld, HN, Lester, RG. Congenital heart disease. Correlation of pathologic anatomy and angiography. WB Saunders Company - Phildelphi, London 1965, pp 783–792.Google Scholar
7.Khali, KG, Shapiro, I, Kilman, JW. Congenital mitral stenosis. J Thorac Cardiovasc Surg 1975; 70: 40–45.CrossRefGoogle Scholar
8.Carpentier, A, Branchini, B, Cour, JC, Asfaou, E, Villani, M, Deloche, A, Relland, J, D'Allaine, C, Blondeau, P, Piwnica, A, Parenzan, L, Brom, G. Congenital malformation of the mitral valve in children. J Thorac Cadiovasc Surg 1976; 72: 854–860.CrossRefGoogle ScholarPubMed
9.Carpentier, A. Congenital malformation of the mitral valve in: Stark, J, deLevel, M Eds surgery for Congenital Heart Defects Grune and Statton Inc, New York 1983, pp 599–604.Google Scholar
10.Anabtawi, IN, Ellison, RG. Congenital stenosing ring of the left atrio ventricular canal (Supra valvular mitral stenosis). J Tjprac Cardiovasc Surg 1965; 49: 994–998.CrossRefGoogle Scholar
11.Otero, Coto E, Martin, Judez V, Juffe, A, Rufilanchas, JJ, Tellez, G, Maronas, J, Fuguera, Aymerich D. Supravalvular stenotic mitral ring: A new case with surgical correction. J Thorac Cardiovasc Surg 1976; 71: 537–540.CrossRefGoogle Scholar
12.Azcuna, JI, Cabrera, A, Bilbao, F, Estebani, I, Ortega, J. Valvule auriculo-ventriculaire gauche en parachure. Etude clinique, angiocardiographie et anatomie. Présentation de 6 cas. Arch Mal Coeur 1975; 2: 180–188.Google Scholar
13.Glancy, DL, Chang, MY, Dorney, ER, Roberts, WC. Parachute mitral valve. Further observations and associated lesions. Am J Cardiol 1971; 27: 309–313.CrossRefGoogle ScholarPubMed
14.Castaneda, AR, Anderaon, RC, Edwards, JE. Congenital mitral stenosis resulting from anomalous arcade and obstructing papillary muscle. Am J Cardiol 1969; 25: 237–241.CrossRefGoogle Scholar
15.Rosequist, GC. Congenital mitral valve disease associated with coarctation of the aorta. A spectrum that includes parachute deformity of the mitral valve. Circulation 1974; 49: 985–993.CrossRefGoogle Scholar
16.Huhta, JC, Edwards, WD, Danielson, GK. Supavalvular mitral ridge containing the dominant left circumflex coronary artery. J Thorac Cardiovasc Surg 1981; 81: 577–579.CrossRefGoogle ScholarPubMed
17.Chauvaud, S, Carpentier, A. Mitral valve reconstruction in children. in: “Cardiac Disease in Children”, Elsevier Science Publishing Company, Inc. N.Y. 1987 pp 238–245.Google Scholar
18.Chauvaud, S, Jebara, V, Chachques, JC, El Asmar, B, Mihaileanu, S, Perier, P, Dreyfus, G, Relland, J, Couetil, JP, Carpentier, A. Valve extension with Glutaraldehyde - pre- served autologous percardium. Results in mitral valve repair. J Thorac Cardiovasc Surg 1991; 102: 171–178.CrossRefGoogle Scholar
19.Rowlatt, UF, Rimoldi, HJA, Lev, MThe quantitative anatomy of the normal child' heart. Pediat. Clin North Amer 1963; 10: 499–588.CrossRefGoogle Scholar
20.Macartney, FJ, Scott, O, Lonescu, MI, Deverall, PB. Diagnosis and management of parachute mitral valve in supravalvular mitra ring. Br Heart J 1974; 36: 641–645.CrossRefGoogle Scholar
21.Bolling, SF, Lamettpmo, MD, Dick, M II, Rosenthal, A, Bove, EL. Shone's anomaly: operative results and late outcome. Ann Thorac Surg;1990;49:887–893.CrossRefGoogle ScholarPubMed
22.Corno, A, Giannico, S, Leibovitch, S, Mazzera, E, Marcelletti, C. The hypoplastic mitral valve. When should a left atrial left ventricular extracardiac valve conduit be used? J Thorac Cardiovasc Surg 1986; 91: 848–851.CrossRefGoogle ScholarPubMed
23.Laks, H, Hellenbrand, WE, Kleinman, C, Talner, NS. Left atrial-left ventricular for relief of congenital mitral stenosis in infancy. J Thorac Cardiovasc Surg 1980; 80: 782–787.CrossRefGoogle ScholarPubMed
24.Lansing, AM, Elbl, F, Solinger, RE, Rees, AH. Left acrial-left ventrivular bypass for congenital mitral stenosis. Ann Thorac Surg 1983; 35: 665–669.CrossRefGoogle Scholar
25.Mazzera, E, Corno, A, Didonato, R, Balleini, L, Marino, B, Catena, G, Marcelletti, C. Surgical bypass of the systemic atrioventricular valve in children by means of a valved conduit. J Thorac Cardiovasc Surg 1988; 96: 321–325.CrossRefGoogle ScholarPubMed
26.Grenadier, E, Sahn, DJ, Valdes-Cruz, LM, Allen, HD, Oliveira, Lima C, Goldberg, SJ. Two dimensional echo Doppler study of congenital disorder of the mitral valve. Am Heart J 1984; 107: 319–324.CrossRefGoogle ScholarPubMed
27.Silver, MM, Pollock, J, Silver, MD, Williams, WG, Trusler, GA. Calcification in porcine xenograft valves in children. Am J Cardiol 1980; 45: 685–690.CrossRefGoogle ScholarPubMed
28.Thandroyen, FT, Whitton, IN, Pirie, D, Rogers, MA, Mitha, AS. Severe calcification of glutaraldehyde-preserved porcine xenografs in children. Am J Cardiol 1980; 95: 690–693.CrossRefGoogle Scholar
29.Bordon, AN, Soule, L, Reitz, B, Gott, BL, Gardner, TJ. Five year follow-up after valve replacement with St Jude medical valve in infants and children. Circulation 1986; 74 (suppl I): 110–114.Google Scholar
30.Kadoba, K, Jonas, RA, Mayer, JE, Castaneda, AR. Mitral valve replacement in the first year of life. J Thorac Cardiovasc Surg 1900; 100: 762–765.CrossRefGoogle Scholar
31.Coles, JG, William, WG, Watenabe, T, Ducan, KF, Sherret, H, Dasmahapatra, HK, Freedom, RM, Trusler, GA. Surgical experience with reparative techniques in patients with congenital mitral valvular anomalies. Circulation 1987; 76 (suppl III): 117–121.Google ScholarPubMed
32.Stellin, G, Bortolotti, U, Mazzucco, A, Faggian, G, Guerra, F, Daliento, L, Livi, U, Gallucci, V. Repair of congenitally malformed mitral valve in children. J Thorac Cardiovasc Surg 1988;95: 480–485.CrossRefGoogle ScholarPubMed
33.Ino, T, Shimazaki, S, Iwahara, M, Miyazaki, E, Yabuta, K, Inoue, K. Successful balloon mitral commissurotomy in a small child: use of small Inoue balloon catheter. Ann Thorac Surg 1993; 56: 168–170.CrossRefGoogle Scholar
34.Sullivan, ID, Robinson, PJ, De Leval, M, Graham, TP. Membranous supravalvular stenosis: a treatable form of congenital heart disease. J Am Coll Cardiol 1986; 8: 159–164.CrossRefGoogle ScholarPubMed