ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Parachute mitral valve: Morphology and surgical management
Shi-Min Yuan1
1Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, China
DOI : 10.5606/tgkdc.dergisi.2020.18041


Background: This review aims to discuss morphology and surgical management of parachute mitral valve.

Methods: A total of 62 articles in the English language with 330 parachute mitral valve patients were retrieved from the PubMed, HighWire Press, and Cochrane Library databases using specific MeSH terms and keywords between January 2000 and December 2018. In these articles, morphology of parachute mitral valve and surgical treatment options were investigated.

Results: A non-syndromic parachute mitral valve was present in 287 patients (87.0%) and a syndromic parachute mitral valve was present in 43 patients (13.0%). A higher number of patients with a non-syndromic parachute mitral valve presented with congestive heart failure compared to syndromic ones. The patients with a non-syndromic parachute mitral valve often had mitral regurgitation, while syndromic parachute mitral valve patients often had mitral stenosis.

Conclusion: Parachute mitral valves are usually not an isolated lesion and are often characterized by a constellation of pathological changes of the mitral valve leaflets, annulus, commissures, subvalvular apparatus, and supravalvular mitral ring. Therefore, the majority of the patients need one or more surgical operations. The incidence of adverse events such as reintervention, postoperative complete heart block, and mortality is high in these patients.

In 1963, Shone et al.[1] firstly reported the mitral valve pathology of "an insertion of the chordae into a single papillary muscle, producing a funnel-shaped valve", and they defined this lesion as a parachute mitral valve (PMV). Subsequently, Bett and Stovin[2] reported a patient with PMV and bicuspid aortic valve. In PMV, all chords are typically shortened and thickened, and attached to the posteromedial papillary muscle, while the anterolateral papillary muscle is absent.[3-5]

Parachute mitral valve can be an isolated lesion, or one of the constellations of Shone syndrome. McElhinney et al.[6] reported that 25.9% patients with severe congenital mitral stenosis had a PMV. Aslam et al.[7] also reported Shone syndrome in 1.17% of all congenital heart lesions. Shone syndrome mainly consists of four defects: supravalvular mitral membrane, PMV, subaortic stenosis (membranous or muscular), and coarctation of the aorta.[1,8] The solitary papillary muscle and orientation of a severely affected PMV contributes to subaortic stenosis.[9] Although surgical management of PMV is constantly reported, the morphological features of PMV and surgical indications of PMV have been described in limited cases.

In this review, pertinent morphological aspects and surgical management of PMV are discussed.


Publications were systematically searched in the PubMed, HighWire Press, and Cochrane Library databases between January 2000 and December 2018. The MeSH terms and keywords were used to identify articles including "parachute mitral valve", "supravalvular mitral ring", "single papillary muscle", "Shone syndrome", "congenital mitral stenosis", "mitral valve repair", and "mitral valve replacement", in the English language. The screening of the bibliographic references helped in completing the literature retrieval. A total of 62 articles including 17 retrospective studies, one case series, and 44 case reports which met the inclusion criteria during initial screening were included in this review. Double-blind, randomized-controlled clinical studies were excluded.

The data independently extracted from each publication were the patient demographics, clinical presentations, mitral valve morphology, cardiac surgical procedures, and patient outcomes.

Statistical analysis
Statistical analysis was performed using the IBM SPSS version 22.0 software (IBM Corp., Armonk, NY, USA). Descriptive data were expressed in mean ± standard deviation (SD), median (min-max) or number and frequency. Independent samples t-test was used to compare quantitative variables. The categorical variables were compared using the chi-square (χ2) or Fisher"s exact test with continuity correction. A p value of <0.05 was considered statistically significant.


In total, 62 articles[3,5-7,9-66] w ith 330 patients were included. A non-syndromic PMV was present in 287 (87.0%) patients and a syndromic PMV (as constellation of pathology of Shone syndrome) was present in 43 (13.0%) patients.

Gender was described for 236 (236/330 patients, 71.5%) and 135 (57.2%) were males and 101 (42.8%) were females. The male-to-female ratio did not differ between patients with non-syndromic and syndromic PMV (128/95 vs. 7/6, χ2=0.1, p=1.000). The mean age of the patients was 21.1±22.0 (range, 0 to 85) years. Age was not specified in 224 patients. A total of 166 (74.1%) patients were pediatric and 58 (25.9%) were adult patients (χ2=104.1, p<0.001). In the nonsyndromic PMV group, 145 (145/177, 81.9%) patients were pediatrics and 32 (32/177, 18.1%) were adults, while in the syndromic PMV group, 21 (21/47, 44.7%) patients were pediatrics and 26 (26/47, 55.3%) patients were adults.

Most PMV patients were symptomatic, while a few patients were asymptomatic in either non-syndromic or syndromic PMV patients (χ2=42.6, p<0.001 for non-syndromic patients, and χ2=16.7, p<0.001 for syndromic patients). Among pediatrics, 17 patients (21.3%) were asymptomatic and 63 patients (78.8%) were symptomatic, while among adults, nine patients (36%) were asymptomatic and 16 patients (64%) were symptomatic (χ2=2.2, p=0.184). A higher number of patients with a non-syndromic PMV presented with congestive heart failure compared to syndromic ones. The patients with a non-syndromic PMV were mostly associated with an atrioventricular septal defect and hypoplastic left ventricle than those with a syndromic PMV. However, the patients with a syndromic PMV had a higher incidence of coarctation of the aorta, bicuspid aortic valve, and subaortic obstruction (Table 1).

Table 1: Comparisons between non-syndromic and syndromic PMV patients

Hemodynamic studies showed that the peak and mean mitral pressure gradients did not significantly differ between the groups (Table 1). All patients had a single papillary muscle. Most patients had a thickened mitral valve leaflet, shortened chords, and mitral stenosis or regurgitation. The patients with a non-syndromic PMV often had mitral regurgitation, while those with a syndromic PMV had mitral stenosis (Table 2).

Table 2: Hemodynamic, metrology, and morphology of PMV

Management was described for 216 patients. Accordingly, 20 patients (9.3%) were not operated due to conservative treatment/on a follow-up/waiting for surgical operation/operation refusal/sudden death, and loss of surgical opportunity,[12,13,15,21,22,25,26,29,41,42,45,48-52,57,66] while 196 patients (90.7%) received a total of 198 surgical operations as follows: non-mitral valve operations (n=70, 35.4%)[3,11,14,26,30,33,36,39,46,61] and mitral valve operations (n=128, 64.6%). Mitral valve operations were prevailed by double patch repair for atrioventricular septal defects (n=20, 15.6%),[44] surgical mitral valvuloplasty (n=17, 13.3%),[5,66] mitral valve replacement (MVR) (n=16, 12.5%),[3,5,9,26,34,36,59,62,66] and zone of apposition closure (n=16, 12.5%).[58] Reintervention was required in 19 patients (19/196, 9.7%).[3,9,16,17,26,58,60]

The mean follow-up of the patients was 150.7±145.6 months (range, 1 month to 20 years) (n=21). The outcomes of 231 patients were reported as follows: 191 (82.7%) recovered, six (2.6%) were complicated, and 34 (14.7%) died.


Parachute mitral valve is formed by specific malformations of the mitral leaflets per se, as well as subvalvular structures (Table 3). The major morphology of PMV is a single papillary muscle, or one papillary muscle is severely hypoplastic. Chauvaud[67] proposed that, in PMV patients, mitral regurgitation might be caused by hypoplasia of one papillary muscle, commissural enlargement, valve leaflet defects, and shortened chords. The authors reported that the hypoplastic papillary muscle was usually the posterior one, while the other papillary muscle was medially displaced. However, some others[39,43,45,48,53,62] reported the dominant papillary muscle was the posterior one. The results of this study supported the posterior papillary muscle was the dominant one.

Table 3: Morphology of PMV[17]

The combination of lesions can give rise to a funnel configuration of the mitral valve. Three-dimensional echocardiography can visualize all characteristic findings of PMV including the absence of one papillary muscle, a funnel-shaped mitral valve, a doming-shaped elongated chordae tendineae, and a pear-shaped left atrium.[18] A supramitral ring in a form of membranous or fibrous shelf is often an integral part of the PMV, thereby, significantly reducing the effective orifice area of the mitral valve.[68]

The characterized single papillary muscle which receives all chords confirms true PMV. Conversely, two papillary muscles with all chordae inserting into one muscle and the other being hypoplastic indicate a parachute-like mitral valve.

According to the literature review, the mean mitral valve annulus diameter was 8.2 (range, 7 to 10) mm, which corresponds to a z-score of -0.665 on the basis of the normal range for newborns (10±2.6 mm).[66]

Surgical treatment and outcomes
Serraf et al.[69] reported that PMV-related mitral stenosis often caused failure of biventricular repair in newborns with borderline small left ventricles, thus strengthening the importance of the left ventricular inflow status in decision making for either a uni- or a biventricular treatment strategy.

Balloon mitral valvuloplasty decreased the peak and the mean mitral valve gradients by a median of 33% and 38%, respectively; however, 54.5% (6/11) patients with a supravalvular mitral ring developed significant mitral regurgitation following balloon mitral valvuloplasty.[6]

Mitral repair has been a preferred procedure as opposed to MVR. In some patients, repair of a stenotic PMV was performed through a papillary muscle incision and leaflet fenestration.[70] In children, MVR shows several drawbacks, such as high operative mortality, significant incidence of complete heart block and pacemaker implantation, lack of prosthetic valves with sizes and with growth potential that are suitable for small children, difficulties in postoperative anticoagulant therapy, and rapid bioprosthetic valve deterioration.[71]

Shone et al.[1] reported that mitral valve obstruction was the most critical problem of this lesion. The severity of the mitral valve obstruction was found to be inversely correlated with long-term outcomes, and the operative mortality of patients with Shone syndrome was eventually adversely affected.[66] However, Marino et al.[39] found no significant association between progressive mitral stenosis and PMV type, dominant papillary muscle, sex, or any surgical or interventional therapies.

As PMVs are usually not isolated lesions and are characterized by a constellation of pathological changes of the mitral valve leaflets, annulus, commissures, subvalvular apparatus, and supravalvular mitral ring, the majority of patients need one or more surgical operations and the reintervention rate is high.[39]

In conclusion, about two-thirds of parachute mitral valve patients require surgical treatment of the mitral valve lesions. Parachute mitral valves are curable by mitral valve repair in most cases, and mitral valve replacement is indicated only for patients with severe mitral valve lesions.

Declaration of conflicting interests
The author declared no conflicts of interest with respect to the authorship and/or publication of this article.

The author received no financial support for the research and/or authorship of this article.


1) Shone JD, Sellers RD, Anderson RC, Adams P Jr, Lillehei CW, Edwards JE. The developmental complex of "parachute mitral valve," supravalvular ring of left atrium, subaortic stenosis, and coarctation of aorta. Am J Cardiol 1963;11:714-25.

2) Bett JH, Stovin PG. Parachute deformity of the mitral valve. Thorax 1969;24:632-6.

3) Brown JW, Ruzmetov M, Vijay P, Hoyer MH, Girod D, Rodefeld MD, et al. Operative results and outcomes in children with Shone"s anomaly. Ann Thorac Surg 2005;79:1358-65.

4) Séguéla PE, Houyel L, Acar P. Congenital malformations of the mitral valve. Arch Cardiovasc Dis 2011;104:465-79.

5) Turkoz R, Ayabakan C, Vuran C, Omay O, Yildirim SV, Tokel NK. Duplicate mitral valve in an infant with Shone"s anomaly. Ann Thorac Surg 2009;88:1683-5.

6) McElhinney DB, Sherwood MC, Keane JF, del Nido PJ, Almond CS, Lock JE. Current management of severe congenital mitral stenosis: outcomes of transcatheter and surgical therapy in 108 infants and children. Circulation 2005;112:707-14.

7) Aslam S, Khairy P, Shohoudi A, Mercier LA, Dore A, Marcotte F, et al. Shone complex: an under-recognized congenital heart disease with substantial morbidity in adulthood. Can J Cardiol 2017;33:253-9.

8) Carey LS, Sellers RD, Shone JD. Radiologic findings in the developmental complex of parachute mitral valve, supravalvular ring of left atrium, subaortic stenosis, and coarctation of aorta. Radiology 1964;82:1-10.

9) Schaverien MV, Freedom RM, McCrindle BW. Independent factors associated with outcomes of parachute mitral valve in 84 patients. Circulation 2004;109:2309-13.

10) Abelson M. Parachute mitral valve and a large ventricular septal defect in an asymptomatic adult. Cardiovasc J S Afr 2001;12:212-4.

11) Agnoletti G, Raisky O, Boudjemline Y, Ou P, Bonnet D, Sidi D, et al. Neonatal surgical aortic commissurotomy: predictors of outcome and long-term results. Ann Thorac Surg 2006;82:1585-92.

12) Akgüllü C, Erdoğan E. Adult patient with Shone"s syndrome and patent ductus arteriosus: a case report. Turk Kardiyol Dern Ars 2012;40:350-3.

13) Almeida S, Cotrim C, Miranda R, Lopes L, Almeida AR, Loureiro MJ, et al. The role of echocardiography in assessing parachute mitral valve. Rev Port Cardiol 2009;28:335-9.

14) Bobylev D, Meschenmoser L, Boethig D, Horke A. Surgical repair of Shone"s complex with anomalous origin of the left coronary artery arising from the right pulmonary artery. Interact Cardiovasc Thorac Surg 2015;20:439-42.

15) Chandra S, Kharwar RB, Mundhekar A. Shone complex. J Cardiovasc Ultrasound 2015;23:54-5.

16) Cho S, Kim WH, Kwak JG, Lee JR, Kim YJ. Surgical results of mitral valve repair for congenital mitral valve stenosis in paediatric patients. Interact Cardiovasc Thorac Surg 2017;25:877-82.

17) Delmo Walter EM, Hetzer R. Repair for congenital mitral valve stenosis. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2018:46-57.

18) Demirkol S, Baysan O, Celik T, Kurt IH, Kucuk U, Balta S. Incremental value of three-dimensional transesophageal echocardiography in a patient with parachute mitral valve. Echocardiography 2012;29:E24-5.

19) Demirkol S, Arslan Z, Balta S, Küçük U. A parachute mitral valve accompanying persistent left superior vena cava: assessment by three-dimensional transthoracic echocardiography. Anadolu Kardiyol Derg 2012;12:E23-4.

20) Dibardino DJ, Fraser CD Jr, Dickerson HA, Heinle JS, McKenzie ED, Kung G. Left ventricular inflow obstruction associated with persistent left superior vena cava and dilated coronary sinus. J Thorac Cardiovasc Surg 2004;127:959-62.

21) Ekici B, Erkan AF, Sökmen Y, Tüfekçioğlu O. Shone"s complex with dextrocardia and situs inversus totalis: a case report. Turk Kardiyol Dern Ars 2012;40:612-4.

22) Espinola-Zavaleta N, Chugh R, Ramírez GM. Parachute mitral valve with severe mitral regurgitation in an adult patient. Echocardiography 2012;29:E122-5.

23) Fisher D, Dipietro A, Murdison KA, Lemieux CA. Full monosomy 21: echocardiographic findings in the third molecularly confirmed case. Pediatr Cardiol 2013;34:733-5.

24) Gokhroo RK, Bisht DS, Padmanabhan D, Gupta S. Association of large muscular ventricular septal defect with parachute mitral valve: A rare case report. Indian J Cardiol 2013;16:64-6.

25) Gori T, Salerno D, Donati G. "Parachute" accessory mitral leaflet and pulmonary valve stenosis in an asymptomatic 85-year-old man. Eur Heart J 2008;29:223.

26) Grimaldi A, Vermi AC, Maisano F, Sacco F, Castiglioni A, Zangrillo A, et al. Echocardiographic patterns of incomplete Shone"s syndrome in adults. J Heart Valve Dis 2011;20:552-6.

27) Henaine R, Nloga J, Wautot F, Yoshimura N, Rabilloud M, Obadia JF, et al. Long-term outcome after annular mechanical mitral valve replacement in children aged less than five years. Ann Thorac Surg 2010;90:1570-6.

28) Hosseinpour AR, Amanullah M, Ramnarine IR, Stümper O, Barron DJ, Brawn WJ. Combined atrial arterial switch operation (double switch) for hearts with Shone syndrome and pulmonary hypertension. J Thorac Cardiovasc Surg 2006;131:471-3.

29) Isılak Z, Deveci OS, Yalcın M, Uz O, Dogan M, Uzun M. A unique case of parachute mitral valve in an adult: an abnormally long chorda tendinea. Echocardiography 2012;29:E245-6.

30) Jain D, Martel M, Reyes-Múgica M, Parkash V. Heterotopic nephrogenic rests in the colon and multiple congenital anomalies: possibly related association. Pediatr Dev Pathol 2002;5:587-91.

31) Jiang ZY, Pircova A, Sekarski N, Hack I, Laurini R, Janzer R, et al. Transposition of the great arteries, pulmonary atresia, and multiple ventricular septal defects associated with multiple cardiac rhabdomyomas in a case of tuberous sclerosis. Pediatr Cardiol 2000;21:165-9.

32) Kim WH, Lee TY, Kim SC, Kim SJ, Lee YT. Unbalanced atrioventricular septal defect with parachute valve. Ann Thorac Surg 2000;70:1711-2.

33) Kurtul A, Duran M, Akkaya E, Ornek E. Parachute mitral and tricuspid valves together with ventricular septal defect. Turk Kardiyol Dern Ars 2013;41:264.

34) López-Pardo F, Urbano-Moral JA, González-Calle A, Laviana-Martinez F, Esteve-Ruiz I, Lagos-Degrande O, et al. Three-Dimensional Transesophageal Echocardiography in the Anatomical Assessment of Isolated Parachute Mitral Valve in an Adult Patient. Echocardiography 2015;32:1732-5.

35) Lorenzo N, Claver E, Alió J, Aguilar R. Incomplete Shone"s complex in the sixth decade of life: echo and cardiac magnetic resonance imaging assessment. Eur Heart J 2017;38:459.

36) Lu M, Tang H. 3166: Echocardiographic in the diagnosis of parachute mitral valve. Ultrasound Med Biol 2006;32:P219.

37) Ma XJ, Huang GY, Liang XC, Liu XQ, Jia B. Atypical Shone"s complex diagnosed by echocardiography. Pediatr Cardiol 2011;32:442-8.

38) M?dry W, Karolczak MA, Grabowski K. Supravalvar mitral ring with a parachute mitral valve and subcoarctation of the aorta in a child with hemodynamically significant VSD. A study of the morphology, echocardiographic diagnostics and surgical therapy. J Ultrason 2017;17:206-11.

39) Marino BS, Kruge LE, Cho CJ, Tomlinson RS, Shera D, Weinberg PM, et al. Parachute mitral valve: morphologic descriptors, associated lesions, and outcomes after biventricular repair. J Thorac Cardiovasc Surg 2009;137:385-93.e4.

40) Meenakshi K, Chidambaram S, Dhandapani VE, Rameshwar R. A rare association of parachute mitral valve with double outlet right ventricle and severe pulmonary hypertension in an adult. J Assoc Physicians India 2014;62:50-2.

41) Mohan JC, Shukla M, Mohan V, Sethi A. Parachute mitral valve and Pacman deformity of the ventricular septum in a middle-aged male. Indian Heart J 2016;68:S126-S30.

42) Mohan JC, Shukla M, Sethi A. Parachute deformity of both atrioventricular valves with congenitally corrected transposition in an adult. Indian Heart J 2015;67:565-9.

43) Motoda H, Murata M, Iwanaga S, Matsushita K, Nakamizo H, Wakino S, et al. Parachute mitral valve incidentally diagnosed in an adult patient with hypertension. J Echocardiogr 2010;8:28-9.

44) Myers PO, del Nido PJ, Bautista-Hernandez V, Marx GR, Emani SM, Pigula FA, et al. Biventricular repair for common atrioventricular canal defect with parachute left atrioventricular valve. Eur J Cardiothorac Surg 2016;49:546-51.

45) Nikolic A, Joksimovic Z, Jovovic L. Exuberant accessory mitral valve tissue with possible true parachute mitral valve: a case report. J Med Case Rep 2012;6:292.

46) Nkoke C, Lekoubou A, Yonta EW, Dzudie A, Kengne AP. Shone"s anomaly: a report of one case in sub-Saharan Africa. Cardiovasc Diagn Ther 2014;4:495-8.

47) Park SJ, Kwak CH, Hwang JY. Long-term survival in double inlet left ventricle combined with pulmonary stenosis and parachute mitral valve: a rare case. Int Heart J 2007;48:261-7.

48) Patsouras D, Korantzopoulos P, Kountouris E, Siogas K. Isolated parachute mitral valve as an incidental finding in an asymptomatic hypertensive adult. Clin Res Cardiol 2007;96:38-41.

49) Popescu BA, Jurcut R, Serban M, Parascan L, Ginghina C. Shone"s syndrome diagnosed with echocardiography and confirmed at pathology. Eur J Echocardiogr 2008;9:865-7.

50) Prunier F, Furber AP, Laporte J, Geslin P. Discovery of a parachute mitral valve complex (Shone"s anomaly) in an adult. Echocardiography 2001;18:179-82.

51) Purvis J, Sharma D. Adult parachute mitral valve detected in pregnancy. Heart 2011;97:1192.

52) Purvis JA, Smyth S, Barr SH. Multi-modality imaging of an adult parachute mitral valve. J Am Soc Echocardiogr 2011;24:351.e1-3.

53) Rybicka J, Dobrowolski P, Ku?mierczyk M, Róza?ski J, Kowalski M, Hoffman P. Parachute mitral valve in a young adult with recurrent pulmonary oedema. Acta Cardiol. 2011;66:401-3.

54) Sadeghian H, Savand-Roomi Z. Parachute mitral valve. In: Sadeghian H, Savand-Roomi Z, editors. Echocardiographic Atlas of Adult Congenital Heart Disease. Cham: Springer; 2015. p. 349-50.

55) Saroli T, Gelehrter S, Gomez-Fifer CA, van der Velde ME, Bove EL, Ensing GJ. Anomalies of left coronary artery origin affecting surgical repair of hypoplastic left heart syndrome and Shone complex. Echocardiography 2008;25:727-31.

56) Saura D, Campos JV, Villegas M, Picó F, de la Morena G, Valdés-Chávarri M. Heart-hand syndrome. Int J Cardiol 2008;129:e7-9.

57) Sethi R, Kharwar RB, Sharma A, Kumar V, Narain VS. Multimodality imaging of holmes heart with parachute mitral valve. Echocardiography 2014;31:E132-5.

58) Sharma V, Burkhart HM, Schaff HV, Cetta F, Cabalka A, Dearani JA. Management of zone of apposition in parachute left atrioventricular valve in atrioventricular septal defect. Ann Thorac Surg 2013;95:1665-9.

59) Shehatha JS, Taha AY, Mirza AJ. Late Shone complex: A case report and literature review. J Egypt Soc Cardio-Thorac Surg 2018;26:133-5

60) Stellin G, Padalino MA, Vida VL, Boccuzzo G, Orrù E, Biffanti R, et al. Surgical repair of congenital mitral valve malformations in infancy and childhood: a single-center 36-year experience. J Thorac Cardiovasc Surg 2010;140:1238-44.

61) Takawira FF, Sinyangwe G, Mwangi MN, Mathivha TM. Case report and images in cardiology: Shone"s complex variant associated with a patent ductus arteriosus: simultaneous treatment of coarctation and patent ductus arteriosus using a covered stent. SAHeart 2010;7:282-6.

62) Vistarini N, Belaidi M, Desjardins G, Pellerin M. Parachute Mitral Valve. Can J Cardiol 2016;32:1261.e5-6.

63) Vivas MF, Politi MT, Riznyk LM, Castro MF, Avegliano G, Ronderos R. Shone"s syndrome: Insights from three-dimensional echocardiography. Echocardiography 2018;35:417-9.

64) Wagner F, Gebauer RA, Paech C. Newborn in cardiogenic shock. Heart 2018;104:467.

65) Yamamoto T, Onishi T, Omar AM, Norisada K, Tatsumi K, Matsumoto K, et al. Isolated true parachute mitral valve in an asymptomatic elderly patient. J Echocardiogr 2010;8:131-2.

66) Zucker N, Levitas A, Zalzstein E. Prenatal diagnosis of Shone"s syndrome: parental counseling and clinical outcome. Ultrasound Obstet Gynecol 2004;24:629-32.

67) Chauvaud S. Surgery of congenital mitral valve disease. J Cardiovasc Surg (Torino) 2004;45:465-76.

68) Remenyi B, Gentles TL. Congenital mitral valve lesions: correlation between morphology and imaging. Ann Pediatr Cardiol 2012;5:3-12.

69) Serraf A, Piot JD, Bonnet N, Lacour-Gayet F, Touchot A, Bruniaux J, et al. Biventricular repair approach in ductodependent neonates with hypoplastic but morphologically normal left ventricle. J Am Coll Cardiol 1999;33:827-34.

70) Zias EA, Mavroudis C, Backer CL, Kohr LM, Gotteiner NL, Rocchini AP. Surgical repair of the congenitally malformed mitral valve in infants and children. Ann Thorac Surg 1998;66:1551-9.

71) Jaquiss RD. Excellent Early; Not-So-Excellent Late. Semin Thorac Cardiovasc Surg 2016;28:461-2.

Keywords : Cardiac surgery; mitral valve annuloplasty; mitral valve stenosis
Viewed : 4113
Downloaded : 651