ArticleEuropean journal of pediatrics2026
Preoperative echocardiographic predictors of mitral valve repair failure in children.
Article in European journal of pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The objective of this study is to identify preoperative echocardiographic predictors of mitral valve (MV) repair failure in pediatric patients. Pediatric patients with mitral regurgitation (MR) grade ≥ 2 who received MV repair between January 2019 and July 2024 were retrospectively reviewed. MV repair failure was defined as a composite of postoperative functional MV failure, heart transplantation, or death. MV morphology and related parameters were assessed using two- and three-dimensional echocardiography. A total of 309 pediatric patients were included, with a median age of 15.50 (6.00, 52.30) months; 164 (53.1%) were male. During a follow-up of 6.93 (1.37, 14.67) months, 11.97% cases experienced MV repair failure. The underdeveloped chordae tendineae (hazard ratio (HR) = 3.69, 95% confidence interval (CI) = 1.46 to 9.33; P = 0.006) and elevated mitral valve annulus area index (MVAI) (HR = 1.23, 95% CI = 1.07 to 1.40; P = 0.003) were identified as two independent preoperative echocardiographic predictors. The significantly dilated mitral annulus, measured with MVAI exceeding 8.73 cm
conclusionFor pediatric patients with MR grade ≥ 2, echocardiography identified underdeveloped chordae tendineae and significantly dilated mitral annulus may serve as crucial preoperative predictors for risk stratification of MV repair failure. WHAT IS KNOWN: • In pediatric populations with mitral regurgitation, MV repair is generally preferred, yet it remains one of the most technically demanding and less predictable congenital cardiac surgeries. WHAT IS NEW: • Preoperative underdeveloped chordae tendineae and enlarged annulus (MVAI > 8.73 cm2/m2) are strong predictors of MV repair failure in pediatric patients, particularly those with isolated MR. These findings support performing repair early, before substantial annular remodeling occurs.
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