Mitral valve operations at a high-volume pediatric heart center: Evolving techniques and improved survival with mitral valve repair versus replacement

Abstract

Mitral valve disease is quite variable and can occur as an isolated defect or in association with other complex left sided lesions. These lesions are often best described with detailed pre-operative imaging studies to define the valve anatomy and to access associated left heart disease. Depending on the type of mitral valve disease, various surgical repair techniques have led to improved survival in the recent era. We describe lesion specific approach to mitral valve repair and results.

Neonatal Mitral Valve Repair in Biventricular Repair, Single Ventricle Palliation, and Secondary Left Ventricular Recruitment: Indications, Techniques, and Mid-Term Outcomes

“…Techniques of valve repair are detailed in Table 2 . Techniques used both in mitral stenosis and regurgitation have previously been described in detail ( 1 , 2 ). In this subset of patients, most were managed with subvalvular repair techniques associated with leaflet repairs.…”

“…Repair of mitral valve disease in children has been steadily increasing ( 1 ), and the results following complex reconstruction are improving ( 1 – 8 ). Congenital mitral valve disease rarely requires intervention in the neonatal period.…”

Inverted Prosthetic Valve Detected by Transesophageal Echocardiography After Mitral Valve Replacement

“…Furthermore, retention of the subvalvular apparatus has been said to offer distinct advantages by conserving the ventricular geometry, leading to improved outcomes after MVR in both adults and children. [2][3][4][5] Despite the aforementioned advantages, remaining subvalvular tissues may hinder motion of the mechanical valve leaflet.…”

“…Activity of the α 2 adrenoceptor regulates norepinephrine secretion in the postganglionic sympathetic neurons and creates a sympatholytic effect. 2 The use of dexmedetomidine theoretically has unique properties in the treatment of the hypertensive crisis that may occur during a pheochromocytoma resection. However, the clinical use of dexmedetomidine in pheochromocytoma resections is limited to a single case report.…”

The left atrioventricular valve: The Achilles' heel of incomplete endocardial cushion defects

“…At primary repair, every effort should be made to address these abnormalities and ensure adequate tension-free coaptation of the LAVV leaflets. 12 As nicely illustrated by Mery and colleagues, 11 younger age at repair is associated with higher rates of left-sided reintervention. Preoperative LAVV morphology and function remain the most important markers for successful repair and thus predictors of postdischarge reintervention on the atrioventricular valve.…”