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Miwa K, Iwai S, Kanaya T, Kawai S. Congenital Mitral Regurgitation Repair Based on Carpentier's Classification: Long-Term Outcomes. World J Pediatr Congenit Heart Surg 2023. [PMID: 36866592 DOI: 10.1177/21501351231157572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND There are few reports of the outcomes of standardized surgical management addressing the etiologic and morphologic aspects of mitral valve malformation according to Carpentier's classification. This study aimed to evaluate the long-term outcomes of mitral valve repair in children according to Carpentier's classification. METHODS Patients who underwent mitral valve repair at our institution between 2000 and 2021 were retrospectively reviewed. Preoperative data, surgical techniques, and outcomes were analyzed according to Carpentier's classification. The proportion of patients free of mitral valve replacement and reoperation was estimated using Kaplan-Meier analysis. RESULTS Twenty-three patients (median operative age, four months) were followed up for 10 (range, 2-21) years. Preoperative mitral regurgitation was severe in 12 patients and moderate in 11 patients. Eight, five, seven, and three patients had Carpentier's type 1, 2, 3, and 4 lesions, respectively. Ventricular septal defect (N = 9) and double outlet of the great arteries from the right ventricle (N = 3) were the most commonly associated cardiac malformations. There were no cases of operative mortality or deaths during the follow-up. The overall five-year rate of freedom from mitral valve replacement was 91%, whereas the five-year rates of freedom from reoperation were 74%, 80%, 71%, and 67% in type 1, 2, 3, and 4 lesions, respectively. Postoperative mitral regurgitation at the last follow-up was moderate in three patients and less than mild in 20 patients. CONCLUSIONS Current surgical management of congenital mitral regurgitation is generally considered adequate; however, more complicated cases required a combination of various surgical techniques.
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Affiliation(s)
- Koji Miwa
- Department of Cardiovascular Surgery, 13608Osaka Women's and Children's Hospital, Osaka, Japan
| | - Shigemitsu Iwai
- Department of Cardiovascular Surgery, 13608Osaka Women's and Children's Hospital, Osaka, Japan
| | - Tomomitsu Kanaya
- Department of Cardiovascular Surgery, 13608Osaka Women's and Children's Hospital, Osaka, Japan
| | - Shota Kawai
- Department of Cardiovascular Surgery, 13608Osaka Women's and Children's Hospital, Osaka, Japan
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Mitral and aortic valve regurgitation following surgical and transcatheter perimembranous ventricular septal defect closure in children and adolescents: midterm outcomes. BMC Cardiovasc Disord 2022; 22:315. [PMID: 35840901 PMCID: PMC9287911 DOI: 10.1186/s12872-022-02757-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Closure of perimembranous ventricular septal defects (pmVSD), either surgical or percutaneous, might improve or cause new-onset mitral regurgitation (MR) and aortic regurgitation (AR). We aimed to evaluate the changes in MR and AR after pmVSD closure by these two methods. MATERIAL AND METHOD We performed a comparative retrospective data review of all pediatric patients with pmVSDs treated at our institution with surgical or antegrade percutaneous methods from 2014 to 2019 and 146 consecutive patients under 18 years were enrolled. We closely looked at the mitral and aortic valve function after repair. Included patients had no or lower than moderate aortic valve prolapse and baseline normal mitral or aortic valve function or less than moderate MR or AR. RESULTS Out of 146 patients, 83 (57%) pmVSDs were closed percutaneously, and 63 (43%) pmVSDs were closed surgically. 80 and 62 patients were included for MR evaluation, and 81 and 62 patients for AR evaluation in percutaneous and surgical groups. The mean follow-up time was 40.48 ± 21.59 months in the surgery group and 20.44 ± 18.66 months in the transcatheter group. Mild to moderate degrees of MR and AR did not change or decreased in most patients. In detail, MR of 70% and AR of 50% of the valves were resolved or decreased in both groups. 13% of patients with no MR developed trivial to mild MR, and 10% of patients with no AR showed mild to moderate AR after pmVSD closure in both methods. There was no significant difference between the two methods regarding emerging new regurgitation or change in the severity of the previous regurgitation. CONCLUSION pmVSD closure usually improves mild to moderate MR and AR to a nearly similar extent in both percutaneous and surgical methods among children and adolescents. It might lead to the onset of new MR or AR in cases with no regurgitation.
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Aal AA, Hassan HM, Ezzeldin D, El Sayed M. Impact of percutaneous ventricular septal defect closure on left ventricular remodeling and function. Egypt Heart J 2021; 73:86. [PMID: 34637037 PMCID: PMC8511205 DOI: 10.1186/s43044-021-00215-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Ventricular septal defect (VSD) is the most common congenital heart disease. In patients with large VSD, left side chambers are subjected to volume overload with subsequent chambers dilatation and eccentric left ventricular hypertrophy. Percutaneous closure of VSD has been shown to be an effective method with equal safety and efficacy when compared to surgery. The effect of VSD closure on LV remodeling has been mainly assessed in patients treated with surgery and to date published data remain scarce. Therefore, we aim to evaluate the effect of percutaneous VSD closure on different LV parameters. Results Seventeen patients (median age 6 years (IQR 4.75–8 years), 70.6% females) who underwent percutaneous VSD closure were enrolled in the study. Sixteen patients (94%) had perimembranous VSD, and one patient had muscular VSD. The procedure was successful in all patients with no major complications. Nit Occlud® Lê coil device was implanted in 16 patients (94%), and one patient received Amplatzer PDA duct occlude device. At 6-months follow-up, there was a significant reduction in indexed LV dimensions [LVEDD/BSA (median 46.5 mm/m2 vs. 42.9 mm/m2, p = 0.03), LVESD/BSA (median 31.7 mm/m2 vs. 26.7 mm/m2, p = 0.02)], indexed LV volumes [LVEDV/BSA (median 52.6 ml/m2 vs. 37.3 ml/m2, p = 0.02), LVESV/BSA (median 31.7 ml/m2 vs. 23.3 ml/m2, p = 0.02)] and indexed LV mass (median 62.4 gm/m2 vs. 57.9 ml/m2, p = 0.01). There was a significant reduction in LVEDD Z-score (p = 0.01) and LVESD Z-score (p = 0.04). There was no significant change in LV EF. Conclusions Percutaneous VSD closure is associated with improvement of various LV parameters with consequential favorable LV remodeling and function.
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Affiliation(s)
- Amr Abdel Aal
- Cardiology Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
| | - Housam M Hassan
- Cardiology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Dina Ezzeldin
- Cardiology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Maiy El Sayed
- Cardiology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
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Cox K, Algaze-Yojay C, Punn R, Silverman N. The Natural and Unnatural History of Ventricular Septal Defects Presenting in Infancy: An Echocardiography-Based Review. J Am Soc Echocardiogr 2020; 33:763-770. [PMID: 32249125 DOI: 10.1016/j.echo.2020.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Ventricular septal defect (VSD), the most common congenital heart defect, accounts for 40% of heart malformations. Despite this prevalence, there remains no consensus on the utility of echocardiography to guide modern-era treatment. In this study, we evaluated patients with isolated VSDs to test the hypothesis that echocardiographic evidence of left ventricular (LV) volume overload and type of VSD are associated with surgical intervention and to identify useful echocardiographic indicators for management of VSDs in infants and children. METHODS We reviewed 350 patients with VSDs diagnosed during the first year of life. Echocardiographic measurements were made at the time of diagnosis and at the endpoint. The VSD area was calculated using inner edge to inner edge dimensions obtained from two planes and indexed to body surface area. Aortic annulus dimension, left atrium to aortic root ratio, LV end-diastolic diameter, left atrial volume, VSD velocity-time integral, ejection fraction, and pulmonary to systemic blood flow ratio (Qp:Qs) were measured using conventional methods. RESULTS One hundred seventy-seven muscular (50.5%) and 162 perimembranous (46%) VSDs accounted for the vast majority of defects. Only seven (4%) muscular defects required surgical closure, while 76 (47%) perimembranous defects required surgery. Indexed VSD area, VSD to aortic valve ratio, indexed left atrium volume, LV end-diastolic diameter, VSD velocity-time integral, and Qp:Qs at diagnosis were significantly different between the surgical and nonsurgical groups. Ventricular septal defect area > 50 mm2/m2 at initial diagnosis was independently associated with risk for surgery (P = .0055). CONCLUSIONS Indexed VSD area is an echocardiographic variable that can be easily measured at diagnosis and can provide insight into the likelihood of requiring surgical intervention regardless of the type and location of the defect.
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Affiliation(s)
- Kelly Cox
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford University Medical Center, Palo Alto, California.
| | - Claudia Algaze-Yojay
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford University Medical Center, Palo Alto, California
| | - Rajesh Punn
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford University Medical Center, Palo Alto, California
| | - Norman Silverman
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford University Medical Center, Palo Alto, California
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Jang YE, Kwak JG, Min JC, Kim EH, Kim JT, Kim HS, Lee JH. Iatrogenic Mitral Regurgitation After Muscular Ventricular Septal Defect Repair Detected by Transesophageal Echocardiography in a Pediatric Patient. A A Pract 2019; 12:218-220. [PMID: 30575609 DOI: 10.1213/xaa.0000000000000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Young-Eun Jang
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Gun Kwak
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joon-Cheol Min
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun-Hee Kim
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Tae Kim
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee-Soo Kim
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji-Hyun Lee
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Kulyabin YY, Soynov IA, Zubritskiy AV, Voitov AV, Nichay NR, Gorbatykh YN, Bogachev-Prokophiev AV, Karaskov AM. Does mitral valve repair matter in infants with ventricular septal defect combined with mitral regurgitation? Interact Cardiovasc Thorac Surg 2017; 26:106-111. [DOI: 10.1093/icvts/ivx231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/09/2017] [Indexed: 11/13/2022] Open
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Affiliation(s)
- Makoto Ando
- Department of Pediatric Cardiac Surgery, Sakakibara Heart Institute
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Bichell DP. Invited commentary. Ann Thorac Surg 2015; 99:897-8. [PMID: 25742819 DOI: 10.1016/j.athoracsur.2014.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 12/15/2014] [Accepted: 12/23/2014] [Indexed: 11/26/2022]
Affiliation(s)
- David P Bichell
- Department of Pediatric Cardiac Surgery, Monroe Carell, Jr Children's Hospital, Vanderbilt University, 2200 Children's Way, Nashville, TN 37232-9292.
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Cantinotti M, Scalese M, Murzi B, Assanta N, Spadoni I, De Lucia V, Crocetti M, Cresti A, Gallotta M, Marotta M, Tyack K, Molinaro S, Iervasi G. Echocardiographic nomograms for chamber diameters and areas in Caucasian children. J Am Soc Echocardiogr 2014; 27:1279-92.e2. [PMID: 25240494 DOI: 10.1016/j.echo.2014.08.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although a quantitative evaluation of cardiac chamber dimensions in pediatric echocardiography is often important, nomograms for these structures are limited. The aim of this study was to establish reliable echocardiographic nomograms of cardiac chamber diameters and areas in a wide population of children. METHODS A total of 1,091 Caucasian Italian healthy children (age range, 0 days to 17 years; 44.8% female) with body surface areas (BSAs) ranging from 0.12 to 1.8 m(2) were prospectively enrolled. Twenty-two two-dimensional and M-mode measurements of atrial and ventricular chamber diameters and areas were performed. Models using linear, logarithmic, exponential, and square-root relationships were tested. Heteroscedasticity was tested by the White test and the Breusch-Pagan test. Age, weight, height, and BSA, calculated by the Haycock formula, were used as the independent variables in different analyses to predict the mean value of each echocardiographic measurement. The influence of various confounders, including gender, type of delivery, prematurity, and interobserver variability, was also evaluated. Structured Z scores were then computed. RESULTS The Haycock formula provided the best fit and was used when presenting data as predicted values (mean ± 2 SDs) for a given BSA and within equations relating echocardiographic measurements to BSA. Confounders were not included in the final models, because they did not show significant effects for most of the measurements. CONCLUSIONS Echocardiographic reference values are presented for chamber area and diameters, derived from a large population of healthy children. These data partly cover a gap in actual pediatric echocardiographic nomograms. Further studies are required to reinforce these data, as well as to evaluate other parameters and ethnicities.
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Affiliation(s)
| | | | - Bruno Murzi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Isabella Spadoni
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | - Maura Crocetti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | | | - Marco Marotta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Karin Tyack
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | - Giorgio Iervasi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy
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