Isolated Congenital Mitral Regurgitation Repair in Children: Long-term Outcomes of Artificial Rings

Experimental observation on a new chimney-shaped mechanical valve completely implanted above the mitral annulus in animals

Current commercially available prosthetic valves suffer from limited size, high requirements for implantation technique, subvalvular structural destruction, and valve dysfunction due to proliferation of fibrous endothelial tissue. This study aims to perform the preclinical large animal experiments for surgically implanting a chimney-shaped artificial mechanical heart valve with zero left ventricular occupancy, which fully accommodates the movement of the valve leaflets in the valve frame and realizes completely supra-annular surgical implantation. A total of 7 sheep underwent the replacement of artificial valve, and 5 sheep survived normally until anatomical examination. The mechanical properties of these artificial mitral valves remain functionally normal. There was no obvious thromboembolism around the artificial valve and in the important organs. The tissue layer of suture ring was completely organized and endothelialized, and the thickness of tissue layer was about 0.6-1.0 mm. The follow-up of echocardiography showed that the left ventricular ejection fraction was normal (60-70%) before and 6 months after operation. The results of transvalvular pressure gradient and blood flow velocity of artificial valve were normal. Left ventricular retrograde angiography showed that the artificial valve was completely located in the left atrium with good position and normal opening and closing. There was no obvious perivalvular leakage and other abnormalities. At 3 and 6 months, there were no obvious abnormalities in blood routine test, liver and kidney function, and other indexes. The new chimney-shaped artificial mechanical valve implanted completely above the mitral annulus had good wear resistance, histocompatibility, and antithrombotic and hemodynamic performance.

Euclidean and Shape-Based Analysis of the Dynamic Mitral Annulus in Children using a Novel Open-Source Framework

BACKGROUND

The dynamic shape of the normal adult mitral annulus has been shown to be important to mitral valve function. However, annular dynamics of the healthy mitral valve in children have yet to be explored. The aim of this study was to model and quantify the shape and major modes of variation of pediatric mitral valve annuli in four phases of the cardiac cycle using transthoracic echocardiography.

METHODS

The mitral valve annuli of 100 children and young adults with normal findings on three-dimensional echocardiography were modeled in four different cardiac phases using the SlicerHeart extension for 3D Slicer. Annular metrics were quantified using SlicerHeart, and optimal normalization to body surface area was explored. Mean annular shapes and the principal components of variation were computed using custom code implemented in a new SlicerHeart module (Annulus Shape Analyzer). Shape was regressed over metrics of age and body surface area, and mean shapes for five age-stratified groups were generated.

RESULTS

The ratio of annular height to commissural width of the mitral valve ("saddle shape") changed significantly throughout age for systolic phases (P < .001) but within a narrow range (median range, 0.20-0.25). Annular metrics changed statistically significantly between the diastolic and systolic phases of the cardiac cycle. Visually, the annular shape was maintained with respect to age and body surface area. Principal-component analysis revealed that the pediatric mitral annulus varies primarily in size (mode 1), ratio of annular height to commissural width (mode 2), and sphericity (mode 3).

CONCLUSIONS

The saddle-shaped mitral annulus is maintained throughout childhood but varies significantly throughout the cardiac cycle. The major modes of variation in the pediatric mitral annulus are due to size, ratio of annular height to commissural width, and sphericity. The generation of age- and size-specific mitral annular shapes may inform the development of appropriately scaled absorbable or expandable mitral annuloplasty rings for children.