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BACKGROUNDCongenital mitral valve disease (CMVD) presents major challenges in medical and surgical management. Data on predictors of mitral valve (MV) reoperation and value of 3D echocardiography (3DE) in this context are currently limited. Aim of our study was to identify predictors of MV reoperation and to investigate the value of 3DE in risk stratification.METHODSAll children RESULTSOver the course of the study period, 206 children underwent MV reconstruction for CMVD: 105 had mitral stenosis (MS), 75 had mitral regurgitation (MR), and 26 had mixed disease (MD). Of them, 64 (31%) required a MV-reoperation. At multivariable analysis, age P=0.006) and 2D-VCRA (AUC=0.969 vs AUC=0.720,P=0.012), respectively. Decision-tree analysis found that a CONCLUSIONSAge CLINICAL PERSPECTIVESWhat is new?In congenital mitral valve (MV) disease patients undergoing MV reconstruction, changes in 3D effective orifice area (3D-EOA) and 3D vena contracta regurgitant area (3D-VCRA) were found to be independent predictors of MV reoperation.Changes in 3D effective orifice area (3D-EOA) and 3D vena contracta regurgitant area (3D-VCRA) had significantly higher predictive value compared to 2D-echocardiography parameters, i.e. changes in mean gradient, 2D-VCRA and moderate or greater postoperative 2D mitral regurgitation.Decision tree analysis identified cut-off points in changes of 3D-EOA and 3D-VCRA to predict MV reoperation.What are the clinical implications?Changes in 3D-EOA and 3D-VCRA can be measured in the operating room to consider return to bypass, or at discharge, to help inform need for early follow-up and MV reoperation.3DE-based decision tree predictive algorithms may help in risk stratification and serve as a support tool to facilitate clinical decision-making. |
