Clinical results of commissure plication annuloplasty for mitral regurgitation in children

Purpose: We evaluated the clinical results of commissure plication annuloplasty for mitral regurgitation (MR) in children. Methods: Twenty-eight patients underwent a valve repair with commissure plication annuloplasty for MR from 1988 to 2005. The mean age was 2.7 ± 3.3 years. Several appropriate techniques were combined (cleft closure in 5 patients, chordal shortening in 2 patients, artificial chordal replacement in 4 patients, leaflet fixation in 2 patients, and so on). The mean follow-up period was 6.2 years. Results: There was one operative death (3.6%) and no late deaths. Two patients underwent a second repair 19 and 23 months after their initial repairs. The actuarial freedom from the reoperation rate was 90.4% ± 0.6% at 10 years. The freedom from moderate MR or more was shown to decrease over time, 87.8% ± 0.7% at 5 years and 78.0% ± 11.0% at 10 years. Furthermore, the 10-year freedom from mild MR or more was 56.5% ± 11.9%. A progression of MR was seen. Most of the residual or recurrent MR cases weighed less than 10 kg at operation. Conclusions: The combination of commissure plication annuloplasty and several appropriate techniques provided adequate results for MR in children. Since a progression of MR was observed, a careful follow-up is therefore needed in such cases.