Assessment by cross sectional echocardiography of surgical "mitral valve" disease in children and adolescents

The anatomy of the left atrioventricular valve, a mitral valve unless there is atrioventricular discordance, was determined by cross sectional echocardiography in 15 young patients with congenital lesions and seven with rheumatic lesions. These results were compared with findings at operation. The preoperative diagnosis was accurate in 18 (80%). In the remaining four patients inaccurate echocardiographic diagnosis was due to the mistaken identification of clefts in redundant and multicuspid valves and of absent chordae that were thought to be ruptured chordae. In four patients a subvalvar abnormality was identified by echocardiography. With care, cross sectional echocardiography was a reliable method of defining abnormal anatomy in serious mitral disease and it predicted the need for replacement or the possibility of repair. In the absence of additional lesions invasive investigation was unnecessary.     

Echocardiographic demonstration of important abnormalities of the mitral valve in congenitally corrected transposition.

Whereas abnormalities of the morphological tricuspid valve are common in the setting of discordant atrioventricular connections, there are only a few postmortem reports of abnormalities of the mitral valve in this condition. This report describes two patients with discordant atrioventricular connections, in whom important abnormalities of the mitral valve were found during life by cross sectional echocardiography.     

Echocardiographic demonstration of important abnormalities of the mitral valve in congenitally corrected transposition

Whereas abnormalities of the morphological tricuspid valve are common in the setting of discordant atrioventricular connections, there are only a few postmortem reports of abnormalities of the mitral valve in this condition. This report describes two patients with discordant atrioventricular connections, in whom important abnormalities of the mitral valve were found during life by cross sectional echocardiography.     

Double outlet right ventricle. Cross sectional echocardiographic findings, their anatomical explanation, and surgical relevance.

The precise method of surgical repair of double outlet right ventricle depends both on the relation of the interventricular communication to the cardiac outlets and on the course and insertion of the atrioventricular valve tension apparatus. It may be difficult to connect the interventricular communication with one or other outlet or both either because the interventricular communication is too far from the outlets or because atrioventricular tension apparatus interposes between them. This study was carried out in order to establish whether these details could be recognised preoperatively using cross sectional echocardiography. Forty two echocardiograms were reviewed retrospectively from patients with double outlet right ventricle, excluding those with atrioventricular septal defects and atrioventricular discordance. Ten further such patients were studied prospectively. The diagnosis was confirmed at open heart surgery in 19 patients. The relation of the great arteries and their outlet tracts to each other and to the interventricular communication was readily and accurately predicted. Four patients (7.7%) had no infundibular septum. The remaining 48 had such a septum. In 27 (52%) the interventricular communication was overridden by a great artery. In 14 (27%) it was roofed by the ventriculoinfundibular fold, and in 11 (21%) it was confined to the inlet or trabecular septa. The insertion of chordae tendineae limited the possible surgical options in 12 patients (23.1%) who were distributed unpredictably among the above groups. Four patients had straddling atrioventricular valves. In five, tricuspid tension apparatus inserted into the underside of the infundibular septum and, in two, into the roof of the defect. In one patient the mitral valve inserted into the defect floor. Tricuspid tension apparatus inserted into the floor of the defect in a further nine patients, but this does not compromise surgery. Thus in double outlet right ventricle cross sectional echocardiography can provide unique information necessary for planning of rational surgical management.     

A comparison of the assessment of mitral valve area by continuous wave Doppler and by cross sectional echocardiography.

Transmitral pressure half time (PHT) was assessed by continuous wave Doppler in 44 patients with rheumatic mitral valve stenosis (14, pure mitral valve stenosis; 15, combined mitral stenosis and regurgitation; and 15 with associated aortic valve regurgitation). The mitral valve area, derived from transmitral pressure half time by the formula 220/pressure half time, was compared with that estimated by cross sectional echocardiography. The transmitral pressure half time correlated well with the mitral valve area estimated by cross sectional echocardiography. The correlation between pressure half time and the cross sectional echocardiographic mitral valve area was also good for patients with pure mitral stenosis and for those with associated mitral or aortic regurgitation. The regression coefficients in the three groups of patients were significantly different. Nevertheless, a transmitral pressure half time of 175 ms correctly identified 20 of 21 patients with cross sectional echocardiographic mitral valve areas less than 1.5 cm2. There were no false positives. The Doppler formula significantly underestimated the mitral valve area determined by cross sectional echocardiography by 28(9)% in 19 patients with an echocardiographic area greater than 2 cm2 and by 14.8 (8)% in 25 patients with area of less than 2 cm2. In thirteen patients with pure mitral valve stenosis Gorlin's formula was used to calculate the mitral valve area. This was overestimated by cross sectional echocardiography by 0.16 (0.19) cm2 and underestimated by Doppler by 0.13 (0.12) cm2. Continuous wave Doppler underestimated the echocardiographic mitral valve area in patients with mild mitral stenosis. The Doppler formula mitral valve area = 220/pressure half time was more accurate in predicting functional (haemodynamic) than anatomical (echocardiographic) mitral valve area.     

A comparison of the assessment of mitral valve area by continuous wave Doppler and by cross sectional echocardiography

Transmitral pressure half time (PHT) was assessed by continuous wave Doppler in 44 patients with rheumatic mitral valve stenosis (14, pure mitral valve stenosis; 15, combined mitral stenosis and regurgitation; and 15 with associated aortic valve regurgitation). The mitral valve area, derived from transmitral pressure half time by the formula 220/pressure half time, was compared with that estimated by cross sectional echocardiography. The transmitral pressure half time correlated well with the mitral valve area estimated by cross sectional echocardiography. The correlation between pressure half time and the cross sectional echocardiographic mitral valve area was also good for patients with pure mitral stenosis and for those with associated mitral or aortic regurgitation. The regression coefficients in the three groups of patients were significantly different. Nevertheless, a transmitral pressure half time of 175 ms correctly identified 20 of 21 patients with cross sectional echocardiographic mitral valve areas less than 1.5 cm2. There were no false positives. The Doppler formula significantly underestimated the mitral valve area determined by cross sectional echocardiography by 28(9)% in 19 patients with an echocardiographic area greater than 2 cm2 and by 14.8 (8)% in 25 patients with area of less than 2 cm2. In thirteen patients with pure mitral valve stenosis Gorlin's formula was used to calculate the mitral valve area. This was overestimated by cross sectional echocardiography by 0.16 (0.19) cm2 and underestimated by Doppler by 0.13 (0.12) cm2. Continuous wave Doppler underestimated the echocardiographic mitral valve area in patients with mild mitral stenosis. The Doppler formula mitral valve area = 220/pressure half time was more accurate in predicting functional (haemodynamic) than anatomical (echocardiographic) mitral valve area.     

Use of echocardiography in mitral regurgitation for the assessment of its mechanism and etiology for the morphological analysis of the mitral valve

Echocardiographic assessment of mitral regurgitation allows the diagnosis of its mechanism and cause which are major determinants in the feasibility of mitral valve repair. This assessment is based on a systematic analysis of the different structures of the mitral valve apparatus: mitral annulus (enlargement, calcification), mitral valve morphology (thickening, calcification, floppy valve, vegetations, perforation), mitral valve motion (restriction, identification of the prolapsed leaflets and scallops in patients with mitral valve prolapse or flail leaflets), subvalvular apparatus (ruptured chordae, thickening), papillary muscles, and left ventricular wall. This analysis can diagnose the mechanism of mitral regurgitation according to the Carpentier classification, and can clarify its cause: degenerative lesions (prolapse or flail leaflet with or without ruptured chordae), rheumatic lesions (thickened valves with restricted motion), endocarditis (vegetations, perforation, ruptured chordae), ischemic mitral regurgitation (restricted valve motion with inferior or posterior left ventricular wall asynergy), or functional mitral regurgitation (annular dilatation, displacement of papillary muscles with restricted leaflet motion). Transthoracic echocardiography with harmonic imaging usually allows a comprehensive assessment of functional anatomy of mitral regurgitation. Transesophageal echocardiography is indicated if transthoracic echocardiography is inadequate. It is also indicated just before surgery and as an intraoperative procedure. Real time 3D echocardiography should probably complete the evaluation of mitral regurgitation in the near future.     

Functional anatomy of mitral regurgitation: accuracy and outcome implications of transesophageal echocardiography.

OBJECTIVES: This study was performed to determine the accuracy and outcome implications of mitral regurgitant lesions assessed by echocardiography. BACKGROUND: In patients with mitral regurgitation (MR), valve repair is a major incentive to early surgery and is decided on the basis of the anatomic mitral lesions. These lesions can be observed easily with transesophageal echocardiography (TEE), but the accuracy and implications for outcome and clinical decision-making of these observations are unknown. METHODS: In 248 consecutive patients operated on for MR, the anatomic lesions diagnosed with TEE were compared with those observed by the surgeon and those seen on 216 transthoracic echocardiographic (TTE) studies, and their relationship to postoperative outcome was determined. RESULTS: Compared with surgical diagnosis, the accuracy of TEE was high: 99% for cause and mechanism, presence of vegetations and prolapsed or flail segment, and 88% for ruptured chordae. Diagnostic accuracy was higher for TEE than TTE for all end points (p < 0.001), but the difference was of low magnitude (<10%) except for mediocre TTE imaging or flail leaflets (both p < 0.001). The type of mitral lesions identified by TEE (floppy valve, restricted motion, functional lesion) were determinants of valve repairability and postoperative outcome (operative mortality and long-term survival; all p < 0.001) independent of age, gender, ejection fraction and presence of coronary artery disease. CONCLUSIONS: Transesophageal echocardiography provides a highly accurate anatomic assessment of all types of MR lesions and has incremental diagnostic value if TTE is inconclusive. The functional anatomy of MR defined by TEE is strongly and independently predictive of valve repairability and postoperative outcome. Therefore, the mitral lesions assessed by echocardiography represent essential information for clinical decision making, particularly for the indication of early surgery for MR.     

Mitral valve abnormalities in patients with right ventricular pressure overload. Analysis by real time cross sectional echocardiography.

Abnormalities of the mitral valve in patients with pulmonary stenosis, tetralogy of Fallot, and pulmonary hypertension with right ventricular pressure overload were studied by real time cross sectional echocardiography. Dislocation of the anterior and posterior mitral leaflets at the coaptation zone in systole was present in 16 of 46 cases: nine of 11 (82%) cases of pulmonary hypertension, four of 20 (20%) cases of tetralogy of Fallot, and three of 15 (20%) cases of pulmonary stenosis. The incidence was highest in patients with pulmonary hypertension. In eight of the 16 patients with mitral valve lesions, mitral regurgitation was seen on left ventriculograms or cross sectional Doppler echocardiograms. The dislocation was located near the posteromedial commissure of the anterior mitral leaflet in all cases. These findings are similar to the mitral valve abnormalities seen in patients with secundum atrial septal defect, and therefore may be due to a common cause. No relation could be found between the left ventricular deformity index and the incidence of dislocation of the mitral leaflets. Thus, the reason why this mitral valve abnormality occurs in conditions with right ventricular pressure overload could not be established.     

Mitral valve abnormalities in patients with right ventricular pressure overload. Analysis by real time cross sectional echocardiography

Abnormalities of the mitral valve in patients with pulmonary stenosis, tetralogy of Fallot, and pulmonary hypertension with right ventricular pressure overload were studied by real time cross sectional echocardiography. Dislocation of the anterior and posterior mitral leaflets at the coaptation zone in systole was present in 16 of 46 cases: nine of 11 (82%) cases of pulmonary hypertension, four of 20 (20%) cases of tetralogy of Fallot, and three of 15 (20%) cases of pulmonary stenosis. The incidence was highest in patients with pulmonary hypertension. In eight of the 16 patients with mitral valve lesions, mitral regurgitation was seen on left ventriculograms or cross sectional Doppler echocardiograms. The dislocation was located near the posteromedial commissure of the anterior mitral leaflet in all cases. These findings are similar to the mitral valve abnormalities seen in patients with secundum atrial septal defect, and therefore may be due to a common cause. No relation could be found between the left ventricular deformity index and the incidence of dislocation of the mitral leaflets. Thus, the reason why this mitral valve abnormality occurs in conditions with right ventricular pressure overload could not be established.     

Mitral regurgitation due to ruptured chordae tendineae in patients with hypertrophic obstructive cardiomyopathy.

Mitral valve regurgitation in association with hypertrophic obstructive cardiomyopathy is usually caused by the systolic anterior motion of the anterior mitral leaflet. Recently, five patients were encountered with hypertrophic obstructive cardiomyopathy who had mitral regurgitation due to ruptured chordae tendineae. The diagnosis was confirmed in all patients during operation for left ventricular septal myectomy-myotomy (Morrow procedure). Preoperative identification of ruptured chordae tendineae as the cause of mitral regurgitation was established by transesophageal echocardiography in the three most recent cases. All patients had successful septal myectomy-myotomy for relief of left ventricular outflow obstruction, and mitral valve competence was restored by valve repair rather than by prosthetic valve replacement. The clinical course of these patients illustrates important management considerations as well as the utility of transesophageal echocardiography for diagnosis. Chordal rupture should be considered in the differential diagnosis of mitral regurgitation in patients with hypertrophic obstructive cardiomyopathy, especially in those with acute hemodynamic deterioration.     

Atrial septal aneurysm--a potential cause of systemic embolism. An echocardiographic study

Atrial septal aneurysm is an uncommon condition. Between 1981 and 1984 10 cases of atrial septal aneurysm were diagnosed by real time cross sectional echocardiography performed in 4840 patients. The aneurysm was associated either with mitral valve prolapse (three patients) or with atrial septal defect (three patients) or occurred in isolation (four patients, two of whom had had a previous embolic event leading to the diagnosis of atrial septal aneurysm by cross sectional echocardiography). During cross sectional echocardiography the aneurysm appeared as a localised bulging of the interatrial septum, which was best seen in the subcostal four chamber view and in the parasternal short axis view at the level of the aortic root. The aneurysm either protruded into only the right atrium (five patients) or moved backwards and forwards between the right and the left atria during the cardiac cycle (five patients). This motion pattern might be related to changes in the interatrial pressure gradient. The two patients who had had a systemic embolism were given anticoagulant treatment, but none underwent surgery. It is concluded that the true prevalence of atrial septal aneurysm might have been underestimated before the routine use of cross sectional echocardiography, that cross sectional echocardiography enables definitive diagnosis of this condition by a non-invasive technique, and that an atrial septal aneurysm should be suspected and looked for by cross sectional echocardiography after an unexplained systemic embolism.     

Atrial septal aneurysm--a potential cause of systemic embolism. An echocardiographic study.

Atrial septal aneurysm is an uncommon condition. Between 1981 and 1984 10 cases of atrial septal aneurysm were diagnosed by real time cross sectional echocardiography performed in 4840 patients. The aneurysm was associated either with mitral valve prolapse (three patients) or with atrial septal defect (three patients) or occurred in isolation (four patients, two of whom had had a previous embolic event leading to the diagnosis of atrial septal aneurysm by cross sectional echocardiography). During cross sectional echocardiography the aneurysm appeared as a localised bulging of the interatrial septum, which was best seen in the subcostal four chamber view and in the parasternal short axis view at the level of the aortic root. The aneurysm either protruded into only the right atrium (five patients) or moved backwards and forwards between the right and the left atria during the cardiac cycle (five patients). This motion pattern might be related to changes in the interatrial pressure gradient. The two patients who had had a systemic embolism were given anticoagulant treatment, but none underwent surgery. It is concluded that the true prevalence of atrial septal aneurysm might have been underestimated before the routine use of cross sectional echocardiography, that cross sectional echocardiography enables definitive diagnosis of this condition by a non-invasive technique, and that an atrial septal aneurysm should be suspected and looked for by cross sectional echocardiography after an unexplained systemic embolism.     

Isolated cleft mitral valve: a variety of congenital mitral regurgitation identified by 2-dimensional echocardiography

Nine children with isolated cleft mitral valve, aged 1 day to 12 years, were studied. The electrocardiogram showed a normal QRS axis in 5 subjects. Cardiac catheterization was performed in 4 patients and demonstrated severe mitral insufficiency in 3 but failed to clearly demonstrate a cleft mitral valve or gooseneck deformity. The mitral cleft was confirmed at operation in 2 patients. Two-dimensional echocardiography demonstrated a cleft dividing the anterior mitral leaflet into 2 portions in each patient. The mitral anulus was normally positioned and the atrioventricular septum present. Atrial and ventricular septa were intact. Features similar to anatomic studies such as accessory chordae and thickening of the edges of the cleft with increasing age were also seen. Two-dimensional echocardiography is the only method available to reliably diagnose isolated cleft of the mitral valve.     

Quantitative evaluation of complete endocardial cushion defect using two-dimensional echocardiography

To avoid postoperative mitral valve dysfunction, the common atrioventricular valves of 21 preoperative patients with complete common atrioventricular canal were quantitatively evaluated using two-dimensional echocardiography. The criteria for diagnosing hypoplasia of the left lateral leaflet, which often made complete repair difficult, were also investigated. The patients were 10 boys and 11 girls, who ranged in age from one month to three years and three months. The subcostal short-axis view was used to evaluate the common atrioventricular valves. The sizes of the leaflets and diameters of the ventricles were measured by two-dimensional echocardiography and at surgery. The measurements by both methods were nearly identical, and the correlation coefficient was 0.95. Thus, two-dimensional echocardiography correctly evaluated common atrioventricular valve size. The length of the left lateral leaflet varied from 5 mm to 22 mm. In four patients, it was less than 10 mm, and was under the 99% confidence limit. In all four patients, two papillary muscles were noted in the left ventricle. Two of these patients underwent corrective surgery and died of postoperative mitral valve stenosis. This new technique can prevent postoperative mitral valve dysfunction by estimating preoperatively the appropriate suturing length of the anterior and posterior components of the anterior mitral valve. It is concluded that two-dimensional echocardiography can correctly evaluate the size of common atrioventricular valves, which is often difficult by angiocardiography. Hypoplasia of the left lateral leaflet could be diagnosed when its length was less than 10 mm measured by two-dimensional echocardiography. This technique is more accurate compared to the method which demonstrates the presence of a single papillary muscle in the left ventricle. Corrective surgery for the patients with a hypoplastic left lateral leaflet involves great risks, resulting in postoperative mitral valve stenosis. Preoperative evaluation of a common atrioventricular valve is useful to avoid postoperative mitral valve dysfunction.     

Assessment of left atrial dimensions by cross sectional echocardiography in patients with mitral valve disease

Left atrial dimensions were measured using cross sectional echocardiography in 37 patients with mitral valve disease and 30 normal subjects of similar ages. The anteroposterior (AP), superior-inferior (SI), and medial-lateral (ML) left atrial dimensions were determined at the end of ventricular systole using parasternal long and short axis and apical four chamber views (for SIa and MLa). To assess the reliability of these measurements cross sectional echocardiographic and angiographic left atrial volumes were compared in 19 patients with mitral valve disease, giving an excellent correlation. A moderate correlation was found between the anteroposterior dimension of the left atrium obtained using M mode echocardiography and that obtained using the parasternal short axis and long axis projections. In normal subjects a good correlation was found between SI and ML dimensions, while a lower correlation was found between SI and AP, and ML and AP dimensions. The SI dimension was the major axis of the left atrium and AP dimension the minor axis. In patients with mitral valve disease a good correlation was found between SI and ML dimensions, while SI and ML dimensions had a low correlation with AP dimensions. The AP dimension was the minor axis of the left atrium, while the SI and ML dimensions were not significantly different. All left atrial dimensions were significantly greater in patients with mitral valve disease than in normal subjects. Of 30 patients with at least one dimension increased, all three dimensions were abnormal in 16, two dimensions were increased in 10, and only one dimension was increased in four. AP, SI, and ML dimensions were abnormal in 25, 20, and 27 patients, respectively. Cross sectional echocardiography may provide a reliable estimate of left atrial dimensions. In patients with mitral valve disease a thorough examination of the left atrium using multiple cross sectional views is necessary to detect asymmetric left atrial enlargement and to measure the degree of left atrial dilatation.     

Assessment of left atrial dimensions by cross sectional echocardiography in patients with mitral valve disease.

Left atrial dimensions were measured using cross sectional echocardiography in 37 patients with mitral valve disease and 30 normal subjects of similar ages. The anteroposterior (AP), superior-inferior (SI), and medial-lateral (ML) left atrial dimensions were determined at the end of ventricular systole using parasternal long and short axis and apical four chamber views (for SIa and MLa). To assess the reliability of these measurements cross sectional echocardiographic and angiographic left atrial volumes were compared in 19 patients with mitral valve disease, giving an excellent correlation. A moderate correlation was found between the anteroposterior dimension of the left atrium obtained using M mode echocardiography and that obtained using the parasternal short axis and long axis projections. In normal subjects a good correlation was found between SI and ML dimensions, while a lower correlation was found between SI and AP, and ML and AP dimensions. The SI dimension was the major axis of the left atrium and AP dimension the minor axis. In patients with mitral valve disease a good correlation was found between SI and ML dimensions, while SI and ML dimensions had a low correlation with AP dimensions. The AP dimension was the minor axis of the left atrium, while the SI and ML dimensions were not significantly different. All left atrial dimensions were significantly greater in patients with mitral valve disease than in normal subjects. Of 30 patients with at least one dimension increased, all three dimensions were abnormal in 16, two dimensions were increased in 10, and only one dimension was increased in four. AP, SI, and ML dimensions were abnormal in 25, 20, and 27 patients, respectively. Cross sectional echocardiography may provide a reliable estimate of left atrial dimensions. In patients with mitral valve disease a thorough examination of the left atrium using multiple cross sectional views is necessary to detect asymmetric left atrial enlargement and to measure the degree of left atrial dilatation.     

Magnetic resonance imaging of hearts with atrioventricular valve atresia or double inlet ventricle.

OBJECTIVE--To investigate the effectiveness and limitations of magnetic resonance imaging in defining cardiac anatomy in patients with double inlet ventricle or atrioventricular valve atresia. DESIGN--Magnetic resonance images were reviewed retrospectively without reference to other morphological data. SETTING--A tertiary referral centre for paediatric cardiology. PATIENTS--18 patients (aged 8 days to 27 years) with a suspected univentricular atrioventricular connection. METHODS--Imaging by a 1.5 T whole body magnetic resonance system with imaging planes adjusted to individual patient anatomy to best define the cardiac morphology. A complete sequential diagnosis obtained from an independent interpretation of the images was compared with the diagnosis obtained from cross sectional echocardiography and angiocardiography. RESULTS--There was substantial accord between the diagnosis from magnetic resonance alone and that from other methods. In the six instances where there was not accord the magnetic resonance diagnosis was considered to be correct in two cases and incorrect in three cases. In the remaining case no consensus could be reached. In eight patients magnetic resonance imaging provided anatomical information additional to that from other methods. The strengths of magnetic resonance were in imaging the pulmonary arteries and their abnormalities and identifying juxtaposed atrial appendanges but there were some deficiencies in identifying Blalock-Taussig shunts. CONCLUSION--Magnetic resonance imaging provided detailed information about all aspects of cardiac morphology in patients with a suspected diagnosis of univentricular atrioventricular connection. Often it provided additional information to echocardiography. Its use in selected patients should give valuable complementary information.     

Obstruction of the outflow tract of the left ventricle by accessory mitral valve tissue

Among the causes of left ventricular outflow tract obstruction, accessory mitral valve tissue is one of the last described and least studied. At present echocardiography permits a complete exploration of the atrioventricular valves as well as left ventricular outflow tract. In this study we evaluate the information obtained in four patients with two-dimensional echocardiography and color-coded Doppler by both transthoracic and transesophageal approaches. The information was compared with catheterization results. In none of the three cases in which hemodynamic study was performed, diagnostic angiographic images of the anomaly were obtained. Transesophageal echocardiography gave additional information about the mitral valve and subvalvular apparatus, the site of accessory tissue implantation and associated lesions.     

综合应用二尖瓣成形术治疗复杂二尖瓣关闭不全的中远期效果

目的:回顾性分析综合应用二尖瓣成形术矫治复杂二尖瓣关闭不全的中远期临床效果。方法:2003年1月2014年3月,综合应用多项成形技术修复23例复杂二尖瓣关闭不全患者瓣膜,患者年龄14~71(45±23)岁。术前超声心动图提示二尖瓣关闭不全:中度6例,重度17例,均存在2个以上的反流点;联合应用后瓣矩形切除、前叶三角形切除、腱索缩短、腱索转移、缘对缘二孔化、置入人工腱索、置入人工瓣环等技术修复二尖瓣。术中采用注水试验和经食管超声心动图检查评估成形效果。手术后每年进行1次超声心动图检查,采用Kaplan-Meier方法评估术后随访期死亡率和无二尖瓣反流发生率。结果:全组患者无手术死亡和住院死亡,随访时间为(71±37)个月,2例患者失访(9%),1例患者于术后3年死于心力衰竭,预计11年总体生存率为95%。根据最近一次超声心动图随访结果,22例存活患者中,3例患者分别于术后9个月、72个月和96个月发生中度二尖瓣反流,免于中度以上二尖瓣反流的预计发生率为76.4%。无患者因为二尖瓣反流复发或者其它原因进行二次心脏手术。结论:正确判断二尖瓣闭锁不全的病理改变,综合应用多种成形技术可以取得良好的二尖瓣成形中远期效果。