Eur J Pediatr. 2026 Feb 24;185(3):149. doi: 10.1007/s00431-026-06800-1.
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 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.
PMID:41731184 | DOI:10.1007/s00431-026-06800-1