Purpose: Parachute and hammock valves in children remain the most challenging congenital malformations
to correct. We report our institutional experience with valve-preserving and remodeling
techniques and the long-term outcome in infants and children.
Methods: Between 1992 and March 31, 2011, 12 children, median age 9 months (range 1 month-14
years), underwent mitral valve (MV) repair at our institution. Six (50%) belonged
to age group<1 year. Eight (median age 6 months) had hammock valves and 4 (median
age 1 year) had parachute valves. Seven had class IV mitral insufficiency (MI) and
5 had class III MI. All had moderate mitral stenosis.
Results: Intraoperative findings included dysplastic and shortened chordae, absence of papillary
muscles with fused and thickened commissures in children with hammock valves (HV)
and annular dilatation. Those with parachute valves (PV) had fused and shortened chordae
with single papillary muscles. MV repair was performed using annuloplasty, commissurotomy,
modified Gerbode-Hetzer plication plasty and papillary muscle splitting, applied according
to the presenting morphology. Postoperative echocardiography showed absent to minimal
MI, except in a 1-month-old infant whose MI was progressive and who underwent MV replacement
using a 14-mm biological prosthesis but died 1 week postoperatively. Another 4-month-old
infant underwent repeat MV reconstruction 1 month after the initial repair, but severe
MI persisted; hence he underwent replacement with mechanical valve 2 weeks later and
survived. During the 19-year follow-up, 5 patients with HV and one with PV underwent
repeat MV reconstruction. A 7-month-old infant died of unknown cause 5 years after
the initial repair. Freedom from reoperation was 50% and survival rate was 83.4%.
Age <1 year proved to be a high risk factor for reoperation and mortality (p=0.00).
Conclusions: In children with parachute and hammock valves, surgical repair offers satisfactory
functional outcome during long-term follow-up. Repeat MV repair may be necessary during
the course.