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Paediatric mitral valve disease - from presentation to management

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Abstract

Mitral valve diseases are relatively rare in the paediatric population; however, they can cause considerable mortality and morbidity worldwide. Acquired causes are a major contributor to cardiovascular disease burden in the paediatric population. Diseases can be detected before birth, at birth, or when the child is older and presents with symptoms of advanced heart failure. Definitive management consists of surgical intervention, with mitral valve replacement being the gold standard.

Conclusion: Repair has been gaining popularity; however, its outcomes require further study. Percutaneous mitral balloon valvuloplasty is an emerging technique which holds promise as a bridge to surgical treatment. The effect of these interventions on quality of life must be emphasised and requires further study.

What is Known:

• The epidemiology of mitral valve disease in the paediatric population - predominant causes include rheumatic disease and congenital defects. 

• Mitral valve repair and replacement are the standard treatment methods for paediatric mitral valve disease. 

What is New:

• Emergence of percutaneous mitral valve interventions and their potential as bridge-to-surgery or definitive treatment in high-risk surgical candidates. 

• Recent evidence comparing mitral valve repair and replacement in the paediatric population demonstrates increasing popularity of repair techniques. 

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Abbreviations

ACEi:

Angiotensin converting enzyme inhibitor

ECG:

Electrocardiogram

CAL:

Cleft anterior leaflet

CPL:

Cleft posterior leaflet

IE:

Infective endocarditis

LV:

Left ventricle

MS:

Mitral stenosis

MR:

Mitral regurgitation

MV:

Mitral valve

MVP:

Mitral valve prolapse

MVE:

Mitral valve endocarditis

MVD:

Mitral valve disease

MVR:

Mitral valve replacement

PMBV:

Percutaneous mitral balloon valvuloplasty

TOE:

Transoesophageal echocardiogram

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Author notes

  1. Roshan Ganeshan, Hussain Imtiaz Shah contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Cardiology, University Hospitals Birmingham, Birmingham, UK

    Sashini Iddawela

  2. School of Medicine, University of Liverpool, Liverpool, UK

    Prince Josiah Sajanthan Joseph

  3. UCL Medical School, University College London, London, UK

    Roshan Ganeshan & Hussain Imtiaz Shah

  4. Medical University-Sofia, Sofia, Bulgaria

    Temitope Adebowale Temidayo Olatigbe

  5. Faculty of Life Sciences and Medicine, King’s College London, London, UK

    Anawinla Ta Anyu

  6. Department of Cardiology, Alder Hey Children Hospital, Liverpool, UK

    Khaled Hadi, Abdulla Tarmahomed & Amer Harky

  7. Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK

    Amer Harky

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  1. Sashini Iddawela
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Iddawela, S., Joseph, P.J.S., Ganeshan, R. et al. Paediatric mitral valve disease - from presentation to management. Eur J Pediatr 181, 35–44 (2022). https://doi.org/10.1007/s00431-021-04208-7

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