Outcome of surgical resection of supraannular mitral ring in nine patients

Objective: To evaluate the outcome of our surgical strategy in patients with supraannular mitral ring who were operated on between 2000 – 2011 by a single surgeon.

Methods: Nine consecutive patients were included into our retrospective study. Different accompanying pathologies were observed within this patients group. Three patients had solitary supraannular/intramitral mitral ring. Six patients had concomitant pathologies. Three patients had ventricular septal defect, two patients had Shone's complex with multilevel left ventricular obstruction and one patient had criss-cross atrioventricular connection in a double outlet right ventricle anatomy.

Results: Simple supraannular/intramitral ring resection was performed in three patients and concomitant closure of ventricular septal defect was employed in three patients, with additional papillary muscle division in one patient. Surgical valvotomy of the aortic valve and subaortic fibromuscular resection with aortic patch plasty was necessary in the two patients with Shone's complex, respectively. There was no early mortality. Mean preoperative gradient over the mitral valve decreased from 13.5 ± 4.7 mmHg to 5.0 ± 2.4 mmHg in the transthoracic echocardiography in the early postoperative period. No mitral valve regurgitation was observed. All patients are alive and remain in a good clinical condition after a mean follow-up time of 48 months.

Conclusions: Surgical treatment of supraannular mitral ring can be performed with excellent long-term clinical results even in patients presenting with complex intracardiac pathologies.