Anillo valvular mitral inferior a 15 mm. ¿Qué opciones tenemos cuando la reparación no es posible?

In pediatric age, mitral valve repair is the treatment of choice whenever possible, since it does not alter valve growth and can be a long-term solution. In young children, especially those under 2 years of age, if valve repair is not possible, we should try to delay mitral valve replacement as much as possible, since it presents high mortality, and also since the size of the prosthesis is fixed, it will not adapt to the somatic growth of the patient, and will require replacement of the valve prosthesis.

When a patient with mitral pathology requires surgical treatment, if valve repair is not feasible, and the size of the valve annulus is less than 15 mm, the options are very limited, since there are currently no such small mechanical prostheses. In this article we collect the therapeutic options for patients with a valve annulus less than 15 mm that we can find in the literature, some of them described as clinical cases, or series with a small sample size, which makes it difficult to draw conclusions. We also describe a decision scheme, which could help us choose which is the most appropriate treatment, depending on the size of the mitral valve annulus, although we must keep in mind that the choice of one or another treatment will depend on multiple factors, such as the characteristics anatomical, the surgeon's experience with the different techniques, and the available resources.