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Finucane K. Invited Commentary: A Lesson From Japan: The Art of Repairing the Infant Mitral Valve. World J Pediatr Congenit Heart Surg 2022; 13:699-700. [DOI: 10.1177/21501351221114774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kirsten Finucane
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children’s Hospital, Auckland, New Zealand
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Maeda T, Fujiwara K, Yoshizawa K, Mori O, Wakami T, Shimoji A, Fukunaga N, Okada T, Tamura N, Sakazaki H. Midterm Outcomes After Surgical Management for Mitral Valve Regurgitation in Infancy. World J Pediatr Congenit Heart Surg 2022; 13:689-698. [DOI: 10.1177/21501351221104741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Mitral valve repair is preferred for pediatric mitral valve disease. However, it is technically difficult because of complex lesions, poor surgical exposure, and tissue fragility, especially in infants. We investigated the midterm outcomes of mitral valve surgery for mitral regurgitation in infancy. Methods We retrospectively reviewed 18 patients (aged <12 months old) undergoing mitral valve surgery for mitral regurgitation at our institution between October 2005 and March 2019. The patients had 10 acquired and 8 congenital valve lesions as follows: torn chordae ( n = 6), leaflet prolapse ( n = 4), posterior leaflet hypoplasia ( n = 3), anterior leaflet cleft ( n = 2), infective endocarditis ( n = 1), papillary muscle rupture ( n = 1), and hammock valve ( n = 1). Results All patients initially underwent mitral valve repair. There was no operative mortality, and 1 case of late death. The median follow-up period was 7 years and 9 months. Reoperation was performed in 3 patients, re-repair (twice) in 1 patient with a hammock valve, and mitral valve replacement in 2 patients. Fifteen patients had at most mild mitral regurgitation at the last follow-up. A transmitral mean pressure gradient of over 5 mm Hg was observed in 3 cases, including the patient with a hammock valve. Postoperative mitral annular diameter increased within the normal range in all patients. Survival and reoperation-free rates at 5 and 10 years were 94.4% and 83.0%, respectively. Conclusions Mitral valve repair for mitral regurgitation in infancy is safe and feasible with satisfactory midterm outcomes, even under serious preoperative conditions.
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Affiliation(s)
- Toshi Maeda
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Keiichi Fujiwara
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Kosuke Yoshizawa
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Otohime Mori
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Tatsuto Wakami
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Akio Shimoji
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Naoto Fukunaga
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Tatsuji Okada
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Nobushige Tamura
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Hisanori Sakazaki
- Department of Pediatric Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
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Cesnjevar RA, Cuomo M, Purbojo A, Dittrich S. Strategies for mitral valve disease in children: what, how and when. Eur J Cardiothorac Surg 2021; 60:367-368. [PMID: 33842950 DOI: 10.1093/ejcts/ezab153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Michela Cuomo
- Department of Pediatric Cardiac Surgery, University of Erlangen, Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiac Surgery, University of Erlangen, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, University of Erlangen, Erlangen, Germany
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Wells D, Lehenbauer D, Tweddell JS, Winlaw DS. Caution Required Contextualizing Recommendations for Infants and Neonates in a Pediatric Experience of Mitral Valve Replacement. World J Pediatr Congenit Heart Surg 2021; 12:375-376. [PMID: 33942694 DOI: 10.1177/21501351211004900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dennis Wells
- Division of Cardiothoracic Surgery, 2518Cincinnati Children's Hospital Medical Center, OH, USA.,University of Cincinnati, OH, USA
| | - David Lehenbauer
- Division of Cardiothoracic Surgery, 2518Cincinnati Children's Hospital Medical Center, OH, USA.,University of Cincinnati, OH, USA
| | - James S Tweddell
- Division of Cardiothoracic Surgery, 2518Cincinnati Children's Hospital Medical Center, OH, USA.,University of Cincinnati, OH, USA
| | - David S Winlaw
- Division of Cardiothoracic Surgery, 2518Cincinnati Children's Hospital Medical Center, OH, USA.,University of Cincinnati, OH, USA
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Caldaroni F, Brizard CP, d'Udekem Y. Replacement of the Mitral Valve Under One Year of Age: Size Matters. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2021; 24:57-61. [PMID: 34116783 DOI: 10.1053/j.pcsu.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/11/2022]
Abstract
Surgical management of mitral valve disease in neonates and infants is challenging. When repair is no longer feasible, replacement may become inevitable, but should only be considered as an option of last resort due to the remarkably high rate of associated morbidity and mortality. Mechanical valves are the preferred choice in large annuli, while stented conduits seem promising in smaller ones. In patients with a preoperative mitral valve annulus equal or larger than 15-16 mm, an intra-annular placement of the smallest mechanical valve available should be attempted. In patients with smaller annuli, the placement of a stented valved conduit seems to display a lower mortality risk. Supra-annular implantation of prostheses should be reserved for exceptional cases and to those familiar with this technique because of the high rate of associated complications.
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Affiliation(s)
- Federica Caldaroni
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Heart Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
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