Mid-term outcomes of posterior mitral leaflet extension using fresh autologous pericardium for pediatric mitral regurgitation.

BACKGROUND

Mitral valve repair is the first-line surgical treatment for pediatric mitral regurgitation (MR). However, recurrent MR may occur because of annular enlargement associated with somatic growth. Achieving sufficient leaflet coaptation can be difficult in patients with posterior leaflet shortening or tethering. Posterior leaflet extension using an autologous pericardial patch improves leaflet coaptation; however, reports in pediatric patients remain limited.

OBJECTIVE

This study evaluated the mid-term outcomes of posterior mitral leaflet extension using fresh autologous pericardium in pediatric MR.

METHODS

We retrospectively reviewed six pediatric patients who underwent posterior mitral leaflet extension using fresh autologous pericardium for MR associated with posterior leaflet shortening with or without tethering between January 2008 and December 2025. The median age at surgery was 1.5 (0.8-4.2) years and the median body weight was 8.4 (6.8-13.7) kg. Annuloplasty was performed in all patients. The primary endpoints were mortality and mitral valve reintervention. Serial echocardiography was used to evaluate MR severity and mitral valve function.

RESULTS

The median follow-up was 10.6 (1.7-14.2) years. There were no operative or late deaths. One patient required mitral valve replacement 3 months after surgery because of recurrent MR associated with patch shortening and stiffening. In the remaining patients, MR was mild or less at the last follow-up.

CONCLUSIONS

Posterior mitral leaflet extension using fresh autologous pericardium may serve as a viable surgical option for selected pediatric patients with MR associated with posterior leaflet shortening or tethering.