Valve Surgery Can Forestall Need for Children's Heart

In patients with left-ventricular dysfunction and severe mitral regurgitation secondary to associated cardiac disease, what's good for adults may also be good for kids.

In a study of 12 children with serious heart disease, those with left-ventricular dysfunction from dilated cardiomyopathy who underwent mitral-valve surgery had improvement in symptoms and stabilization of ventricular dysfunction, reported cardiologists from Baylor in Houston.

Among kids with left-ventricular dysfunction associated with other cardiac disease, mitral-valve surgery can restore ventricular function to normal, John Philip Breinholt, M.D., a pediatric cardiology fellow at Baylor, said at the American Academy of Pediatrics meeting here.

The findings suggest that mitral-valve surgery should be considered prior to transplant in children with left-ventricular dysfunction and severe mitral regurgitation from dilated cardiomyopathy, he said.

Pediatric cardiologists "lag behind adult cardiologists in what they do for patients with, maybe not exactly the same disease process, but similar disease processes," Dr. Breinholt said in an interview. "Over the last decade they've started to be a bit more bold about taking these patients into the operating room and trying to do at least a palliative repair as opposed to the definitive repair, i.e. a transplant."

For children with dilated cardiomyopathy, who tend to have disease severity toward the high end of the scale, "their option was list them for transplant and hope you can get it to that point," he added.

Dr. Breinholt and colleagues looked at outcomes of mitral valve surgery in 12 children with left-ventricular dysfunction and severe mitral regurgitation, between the ages of six months and 15 years. Seven of the children had dilated cardiomyopathy, and five had associated cardiac disease, including partial atrioventricular canal, rheumatic mitral valve disease, mitral valve cleft, and an anomalous left coronary artery.

The procedures included valvuloplasty with later replacement, primary mitral valve replacement, and valvuloplasty alone.

Patients with dilated cardiomyopathy had a depressed fractional shortening preoperatively (24.4 ± 6.1%) that remained depressed (22.6 ± 7.1%) 1.1 ± 1.2 years after surgery. Both their Left ventricular end diastolic dimension (6.5 ± 1.5 to 5.0 ± 1.7 Z-scores, p<0.01) and end-systolic dimension (6.8 ± 1.5 to 5.7 ± 2.0 Z-scores, p<0.05) improved.

Patients with other cardiac diseases also had a depressed fractional shortening FS pre-operatively (30.1 ± 3.8%), but this normalized (37.0 ± 5.9%) 3.4 ± 2.8 years after surgery (p=0.05). Left ventricular end systolic dimension also improved in this group (4.0 ± 2.7 to 1.0 ± 3.0 Z-scores, p<0.05). There were no perioperative deaths.

Among the patients with dilated cardiomyopathy, three went on to transplant, two had chronic respiratory problems resolved by surgery, one had failure to thrive that resolved, and one had improved exercise tolerance.