BACKGROUND: Shone's complex is a rare lesion affecting the mitral valve (MV) and 
left ventricular outflow tract (LVOT). The objective of this study is to report 
the outcomes after Shone's complex repair, the growth of mitral and aortic valve 
and LVOT, and long-term survival.
METHODS: This retrospective study included all patients diagnosed with Shone's 
complex, who underwent biventricular repair. Data including patients' 
characteristics, type of the MV lesion and the associated lesions were 
collected. Patients were followed up regularly with echocardiography, and the 
changes in mitral and aortic valve z-score and LVOT z-score were recorded.
RESULTS: Thirty-seven patients were included in the study, the median age was 
3.4 months, and 11 patients (30.6%) had pulmonary hypertension. The main 
procedure performed during the first surgical intervention was coarctation 
repair in 26 patients (70%). Twelve patients had MV repair, and five had MV 
replacement. Operative mortality occurred in 1 patient (2.7%), median follow up 
was 52 (25-75th percentile: 22-84) months. Survival at 1, 5, and 10 years was 
94.4%, 90%, and 76.9%, respectively. Reoperation was required in 13 patients, 
mainly for LVOT repair (n = 8). Reoperation was significantly associated with 
associated aortic valve lesion (p = .044). The growth of the MV z-score was 0.35 
per year; p < .001, aortic valve z-score 0.086 per year; p = 0.422, and the LVOT 
z-score was 0.53 per year; p = .01.
CONCLUSION: Biventricular repair of Shone's complex has good outcomes. 
Reoperation is frequently encountered, especially with low aortic valve z-score. 
The MV and LVOT have significant growth following Shone's complex repair.