LAUSR

BACKGROUND AND AIM: Mitral repair in children is challenging and almost always the only chance: dimensions, anatomy and dysplasia are the main concerns. According to anatomical and literature data valve geometry seems based on well-defined dimensional proportions, determining valve shape and function. We applied these proportions during repair to assess whether they could make the procedure easier and improve results. METHODS: Eight patients underwent mitral repair between 2015 and 2018. Mean age was 93 ± 48 months and weight 26 ± 12 Kg. Six had congenital dysplasia, one a bileaflet prolapse in Loeys-Dietz Syndrome and one an acute endocarditis. Hypoplastic leaflets had an extension plasty, endocarditis a replacement of the anterior leaflet and bileaflet prolapse a posterior quadrangular resection. Chordal surgery and posterior annuloplasty with a pericardial strip were also employed. Proportional Geometry was used to estimate valve dimensions, leaflet extension/resection amount and annuloplasty entity. RESULTS: Mean annular dilatation was 8 mm, according to body weight or BSA, leaflet extension patch had a mean width of 8 mm and the annuloplasty strip a mean length of 53 mm. At intraoperative TE Echocardiography mitral valve appeared normal, with no or trivial regurgitation and no gradient. All patients had an uneventful postoperative course. Follow up is 100% complete and 3 years long. All patients show good clinical conditions, no symptoms and no or trivial mitral regurgitation. CONCLUSIONS: Proportional Geometrical rules standardize surgery and seem to help restoring a normal mitral anatomy, optimizing valve function and mechanical stresses and potentially improving surgical results.