PMID- 11082380
OWN - NLM
STAT- MEDLINE
DCOM- 20001228
LR  - 20190623
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 102
IP  - 19 Suppl 3
DP  - 2000 Nov 7
TI  - Surgical management of mitral regurgitation after repair of endocardial cushion 
      defects: early and midterm results.
PG  - III160-5
AB  - BACKGROUND: Mitral regurgitation (MR) represents the principal indication for 
      reoperation in patients after repair of atrioventricular septal defects (AVSD). 
      Reports of mitral valvuloplasty (MVP) in such patients are few; the alternative, 
      mitral valve replacement (MVR), necessitates commitment to future valve 
      replacement and long-term anticoagulation. We sought to determine the outcome of 
      those patients who underwent either MVP or MVR between January 1, 1988, and 
      December 31, 1998, for significant MR after repair of AVSD. Furthermore, we 
      sought to identify (a) morphological predictors necessitating MVR, and (b) 
      predictors of future reoperation within the MVP group. METHODS AND RESULTS: 
      Retrospective review of clinical, operative, and echocardiographic data were 
      performed. There were 46 patients identified (37 MVP and 9 MVR). The median age 
      at initial AVSD repair was 0.6 years, and the age at subsequent mitral valve 
      operation was 2.8 years. The early postoperative mortality rate was 2.2%, and 
      survival at 1 and 10 years was 89.9% and 86.6%, respectively. A high rate of 
      complete heart block was noted within the MVR group (37.5%). Freedom from later 
      mitral valve reoperation for both groups was similar. No significant 
      morphological predictors necessitating MVR were found. Predictors of reoperation 
      within the MVP group included the presence of moderate or worse MR in the early 
      postoperative period. In both groups New York Heart Association class, degree of 
      MR, growth, and ventricular volumes improved. CONCLUSIONS: Mitral valve surgery 
      significantly improves clinical status, with a sustained improvement in 
      ventricular chamber size. MR can be successfully managed in patients after repair 
      of AVSD independent of morphological type. Overall survival is acceptable, and 
      further reoperation within the MVP group is influenced by early outcome of 
      repair.
FAU - Moran, A M
AU  - Moran AM
AD  - Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, MA 
      02115, USA. Moran_a@a1.tch.harvard.edu
FAU - Daebritz, S
AU  - Daebritz S
FAU - Keane, J F
AU  - Keane JF
FAU - Mayer, J E
AU  - Mayer JE
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - Analysis of Variance
MH  - Body Height/physiology
MH  - Body Weight/physiology
MH  - Cardiovascular Surgical Procedures/*adverse effects/mortality
MH  - Child, Preschool
MH  - Echocardiography
MH  - Endocardial Cushion Defects/*surgery
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Block/epidemiology/etiology
MH  - Heart Function Tests
MH  - Humans
MH  - Infant
MH  - Male
MH  - Mitral Valve/diagnostic imaging/surgery
MH  - Mitral Valve Insufficiency/etiology/mortality/*surgery
MH  - Postoperative Complications/etiology/mortality/surgery
MH  - Reoperation/statistics & numerical data
MH  - Retrospective Studies
MH  - Survival Rate
MH  - Treatment Outcome
EDAT- 2000/11/18 11:00
MHDA- 2001/02/28 10:01
CRDT- 2000/11/18 11:00
PHST- 2000/11/18 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/11/18 11:00 [entrez]
AID - 10.1161/01.cir.102.suppl_3.iii-160 [doi]
PST - ppublish
SO  - Circulation. 2000 Nov 7;102(19 Suppl 3):III160-5. doi: 
      10.1161/01.cir.102.suppl_3.iii-160.