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 cm2/m2, was established as the clinically significant threshold for predicting MV repair failure. Sensitivity analyses revealed a more pronounced predictive effect of MVAI in the isolated MR group (HR = 1.84, 95% CI = 1.19 to 2.85; P = 0.006). Conclusion: For 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.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> 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. </entry> </row> <row> <entry nameend="c2" namest="c1"> 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. </entry> </row> </tbody> </tgroup> </Table>

Preoperative echocardiographic predictors of mitral valve repair failure in children

期刊论文
发表日期：

2026年2月24日

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Yue Gao,
Xinjie Lin,
Qiyu He,
Nan Xu,
Tingting Zhang,
Jiayi Xing,
Rong Wang,
Zheng Dou,
Fengqun Mao,
Shoujun Li,
Kunjing Pang

摘要

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 cm²/m², was established as the clinically significant threshold for predicting MV repair failure. Sensitivity analyses revealed a more pronounced predictive effect of MVAI in the isolated MR group (HR = 1.84, 95% CI = 1.19 to 2.85; P = 0.006).

Conclusion: For 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.