Congenital mitral stenosis with or without associated defects : An evolving surgical strategy

• Published in: Circulation (New York, N.Y.) N.Y.), 2000-11, Vol.102 (19), p.166-171
• Main Authors: SERRAF, Alain, ZOGHBI, Joy, BELLI, Emré, LACOUR-GAYET, Francois, AZNAG, Hakim, HOUYEL, Lucile, LAMBERT, Virginie, PIOT, Dominique, PLANCHE, Claude
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - mortality; Cardiology. Vascular system; Child; Child, Preschool; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Echocardiography; Female; Follow-Up Studies; Heart; Heart Defects, Congenital - complications; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - surgery; Humans; Infant; Male; Medical sciences; Mitral Valve Stenosis - complications; Mitral Valve Stenosis - diagnostic imaging; Mitral Valve Stenosis - surgery; Multivariate Analysis; Proportional Hazards Models; Reoperation - statistics & numerical data; Risk Factors; Survival Rate - trends; Treatment Outcome
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.102.suppl_3.iii-166

Congenital mitral stenosis (CMS) remains a surgical challenge, particularly when it is associated with other heart defects. As in other groups of heart defects, there is a trend toward early single-stage complete repair, but the optimal surgical approach remains unanswered. This study was designed to analyze the evolution of surgical strategies in patients with CMS and associated defects through single-stage and staged repair. Between 1980 and 1999, 72 children were operated on for congenital heart defects, including CMS. Preoperative transmitral gradient was 12.6+/-7 mm Hg. Preoperatively, all the patients were NYHA class III to IV. Thirteen patients had an isolated CMS; in 59, it was associated with other heart defects, mainly ventricular septal defect (n=28) or multilevel left ventricular obstruction (n=41). In this group of patients, 33 had a staged approach, and 26 had a single-stage approach. Early mortality was 12.5% (9 patients). There were no deaths in the isolated CMS and single-stage repair groups. Logistic regression revealed that early mortality was influenced by association with left ventricular outflow tract obstruction (P: