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Rajanbabu BB, Chigullapally R. The effect of distal pulmonary obstruction or elevated atrial pressures on pulmonary flow and pulmonary vascular disease: a mathematical flow circuit analogy model-based analysis. Indian J Thorac Cardiovasc Surg 2020; 35:548-556. [PMID: 33061050 DOI: 10.1007/s12055-019-00816-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/03/2019] [Accepted: 03/07/2019] [Indexed: 10/26/2022] Open
Abstract
Background Late presentation of large left to right shunts is a major problem in developing countries and evaluating the operability is a challenge during preoperative evaluation. The factors that determine the development and progression of the pulmonary vascular disease are still largely unknown, though there is evidence to show that increased pulmonary flow is the main contributing factor. We have found cases of operability despite late presentation of ventricular septal defect (VSD). In some of these cases, the reason for operability may lie in associations. We herein attempt to provide a mathematical explanation for their operability. Aims and objectives To assess the effect of different levels of obstruction and elevated ventricular end-diastolic pressure on pulmonary flow. Materials and methods Mathematical flow analogy models were constructed and analysed based on Ohm's law and the laws governing flow in series and parallel flow circuits. Results Any narrowing in the pulmonary circulation produces a reduction in pulmonary blood flow and the pulmonary to systemic blood flow ratio, irrespective of its position. This increases the systemic flow and blood pressure if the ventricular performance remains constant. A rise in ventricular end-diastolic pressure reduces the total cardiac output, pulmonary flow and systemic blood flow with a preserved pulmonary to systemic flow ratio. The absolute reduction in pulmonary flow will exceed the absolute reduction in systemic flow, with its ratio being in proportion to the ratio of systemic to pulmonary vascular resistance. However, a higher pressure will be transmitted distally in these settings. These mechanisms of flow reduction may prevent irreversible pulmonary vascular disease. Conclusion Distal pulmonary obstruction or elevated ventricular end-diastolic pressure can reduce pulmonary blood flow and may prevent irreversible pulmonary vascular disease. Clinical studies in this direction are recommended for validation.
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Qi L, Ma K, Zhang B, Rui L, Lin Y, Wang G, Li S. Pediatric Mitral Regurgitation: Standardized Repair-Oriented Strategy With Leaflet Plication. Semin Thorac Cardiovasc Surg 2020; 32:1002-1012. [PMID: 32505798 DOI: 10.1053/j.semtcvs.2020.05.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 11/11/2022]
Abstract
To introduce a standardized strategy and reproducible procedures of mitral repair for mitral regurgitation in the pediatric population with leaflet plication as a principal technique. Consecutive patients who had undergone mitral repair by our standardized repair-oriented strategy in our institution from January 2016 to December 2019 were included retrospectively. The standardized repair strategy included 3-step inspections and repair from the subvalvular to leaflet, and then to the annular level. The main surgical techniques included chordae detachment, papillary muscle splitting, leaflet plication, and posterior annuloplasty. The indication for leaflet plication was that the distance between 2 adjacent chordae tendineae was greater than 4 mm. A total of 113 patients were enrolled. During 22.6-month (range, 2-50 months) follow-up period, primary endpoint was documented in 15 (13.3%) patients, including 1 (0.9%) death, 0 transplantation, and 14 (12.4%) functional mitral failure. Freedom form primary endpoints at 6 months, 1 year, and 3 years was 94.7%, 94.7%, and 82.3%, respectively. Significant independent predictors of functional mitral valve failure were younger age (hazard ratio [HR], 0.28; 95% confidence interval [CI], 0.04-0.72; P = 0.037) and ischemic mitral regurgitation (MR) (HR, 24.34; 95% CI, 4.52-47.33; P < 0.001). Leaflet plication was significantly associated with well-functioned mitral valve (HR, 7.42; 95% CI, 2.35-30.54; P = 0.004). Compared with nonischemic MR group, ischemic MR group was noted with higher occurrence of primary endpoint events (11/28 vs 4/85, P < 0.001). The short- to mid-term outcomes of standardized mitral repair technique with leaflet plication were favorable, among which, however, repair for mitral regurgitation with ischemic lesions is comparatively challenging.
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Affiliation(s)
- Lei Qi
- Department of Cardiac Surgery, Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Kai Ma
- Department of Cardiac Surgery, Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Benqing Zhang
- Department of Cardiac Surgery, Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Lu Rui
- Department of Cardiac Surgery, Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Ye Lin
- Department of Cardiac Surgery, Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Guanxi Wang
- Department of Cardiac Surgery, Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China
| | - Shoujun Li
- Department of Cardiac Surgery, Paediatric Cardiac Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China.
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Shi Y, Xu H, Yan J, Wang Q, Li S, Yi T, Zhang Y, Liu W. The Mid-term Results of Mitral Valve Repair for Isolated Mitral Regurgitation in Infancy and Childhood. Pediatr Cardiol 2017; 38:1592-1597. [PMID: 28762165 DOI: 10.1007/s00246-017-1701-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
The objective of this study was to assess the mid-term results of mitral valve (MV) repair in infancy and childhood with isolated mitral regurgitation (MR). From January 2005 to January 2016, 40 consecutive patients with isolated MR underwent MV repair in Fuwai Hospital, Beijing, China. Patients' clinical data were analyzed retrospectively. Mean age at operation was 13 ± 5 (6-24) months and 22 patients (55%) were younger than 1 year. Mean weight at operation was 8.5 ± 1.9 (4.2-13) kg and 34 patients (85%) were lighter than 10 kg. All patients presented moderate or greater MR. After MV repair, all patients had mild MR or none, while two patients underwent re-repair immediately when TEE showed moderate MR. Mean left atrial diameter decreased from 28.0 ± 6.5 to 20.7 ± 4.8 mm and mean left ventricular end-diastolic diameter decreased from 38.6 ± 7.0 to 30.2 ± 4.9 mm (p < 0.001 for both). There was no early death. Clinical follow-up was conducted in 37 patients over an average period of 49 ± 31 (20-134) months. Follow-up echocardiography showed that one patient had severe MR who underwent redo repair 14 months after operation, one patient had moderate to severe MR, and three patients had moderate MR. Overall freedom from moderate or greater MR was 96.3 ± 3.6%, 91.9 ± 5.5%, and 83.6 ± 9.4% at 2, 5, and 10 years, respectively. The early and mid-term results of MV repair in pediatric patients with isolated MR were satisfactory. In majority of patients, less complex surgical repair techniques were utilized, namely annuloplasty or commissuroplasty. The combination of various repair methods in complex patients could achieve excellent outcome.
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Affiliation(s)
- Yi Shi
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Haitao Xu
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Jun Yan
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China.
| | - Qiang Wang
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Shoujun Li
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Tong Yi
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Yajuan Zhang
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
| | - Wenchao Liu
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China
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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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Nishida H, Nakatsuka D, Kawano Y, Hiraiwa N, Takanashi S, Tabata M. Outcomes of Totally Endoscopic Atrial Septal Defect Closure Using a Glutaraldehyde-Treated Autologous Pericardial Patch. Circ J 2017; 81:689-693. [PMID: 28179595 DOI: 10.1253/circj.cj-16-0888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We evaluated the outcomes of totally endoscopic minimally invasive surgery for atrial septal defect (ASD) using a glutaraldehyde-treated autologous pericardial patch in the transcatheter interventional era.Methods and Results:We retrospectively reviewed 37 consecutive patients who underwent totally endoscopic ASD closure with a glutaraldehyde-treated autologous pericardial patch between June 2011 and April 2015. All patients had been deferred from catheter-based intervention for clinical or anatomical reasons. We analyzed operative outcomes and postoperative echocardiographic data. The mean age was 45.7±16.5 years, and 25 patients (67.6%) were women. The mean ratio of pulmonary to systemic flow was 2.4±0.7. Six patients (16.2%) underwent concomitant tricuspid valve repair, and 3 patients (8.1%) underwent concomitant atrial fibrillation surgery. There were no operative deaths, and the median length of hospital stay was 5 days. Postoperative echocardiography revealed trivial residual shunt in 1 patient. During the follow-up period, there were no re-interventions for ASD or readmission for heart failure. Follow-up echocardiography revealed no recurrent shunt or calcification of the autologous pericardial patch. CONCLUSIONS Totally endoscopic ASD closure with a glutaraldehyde-treated autologous pericardial patch demonstrated excellent outcomes. It is a useful option for patients with unfavorable anatomy or other reasons excluding transcatheter intervention.
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Affiliation(s)
- Hidefumi Nishida
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Daisuke Nakatsuka
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
| | - Yuji Kawano
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
| | - Nobuhiko Hiraiwa
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
| | | | - Minoru Tabata
- Department of Cardiovascular Surgery, Sakakibara Heart Institute.,Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
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Jang WS, Cho JY, Lee JU, Lee Y. Surgical Results of Monocusp Implantation with Transannular Patch Angioplasty in Tetralogy of Fallot Repair. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:344-349. [PMID: 27733993 PMCID: PMC5059119 DOI: 10.5090/kjtcs.2016.49.5.344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 11/22/2015] [Accepted: 12/01/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Monocusp reconstruction with a transannular patch (TAP) results in early improvement because it relieves residual volume hypertension during the immediate postoperative period. However, few reports have assessed the long-term surgical outcomes of this procedure. The purpose of the present study was to evaluate the mid-term surgical outcomes of tetralogy of Fallot (TOF) repair using monocusp reconstruction with a TAP. METHODS Between March 2000 and March 2009, 36 patients with a TOF received a TAP. A TAP with monocusp reconstruction (group I) was used in 25 patients and a TAP without monocusp reconstruction (group II) was used in 11 patients. We evaluated hemodynamic parameters using echocardiography during the follow-up period in both groups. RESULTS At the most recent follow-up echocardiography (mean follow-up, 8.2 years), the mean pulmonary valve velocities of the patients in group I and group II were 2.1±1.0 m/sec and 0.9±0.9 m/sec, respectively (p=0.001). Although the incidence of grade 3-4 pulmonary regurgitation (PR) was not significantly different between the two groups (group I: 16 patients, 64.0%; group II: 7 patients, 70.0%; p=0.735) during the follow-up period, the interval between the treatment and the incidence of PR aggravation was longer in group I than in group II (group I: 6.5±3.4 years; group II: 3.8±2.2 years; p=0.037). CONCLUSION Monocusp reconstruction with a TAP prolonged the interval between the initial treatment and grade 3-4 PR aggravation. Patients who received a TAP with monocusp reconstruction to repair TOF were not to progress to pulmonary stenosis during the follow-up period as those who received a TAP without monocusp reconstruction.
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Affiliation(s)
- Woo Sung Jang
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine
| | - Joon Yong Cho
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine
| | - Jong Uk Lee
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine
| | - Youngok Lee
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine
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7
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Affiliation(s)
- Makoto Ando
- Department of Pediatric Cardiac Surgery, Sakakibara Heart Institute
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8
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Jang WS, Kim WH, Cho JY, Choi K, Choi ES, Lee YO, Kim GJ, Lee JR, Kim YJ. Surgical Indications and Results of Mitral Valve Repair in Pediatric Patients With Ventricular Septal Defects Accompanied by Mitral Valve Regurgitation. Ann Thorac Surg 2015; 99:891-7. [DOI: 10.1016/j.athoracsur.2014.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/29/2014] [Accepted: 11/12/2014] [Indexed: 11/27/2022]
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Cho HJ, Ma JS, Cho YK, Ahn BH, Na KJ, Jeong IS. Timing in resolution of left heart dilation according to the degree of mitral regurgitation in children with ventricular septal defect after surgical closure. J Pediatr (Rio J) 2014; 90:71-7. [PMID: 24140379 DOI: 10.1016/j.jped.2013.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 06/05/2013] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Children with ventricular septal defects (VSD) can have chronic volume overload, which can result in changes of left heart echocardiographic parameters. To evaluate the changes before and after surgical closure, the children were divided into three groups according to the degree of mitral regurgitation (MR), and their echocardiographic characteristics were reviewed at serial follow-up after surgical closure. METHODS The preoperative, and one-, three-, and 12-month postoperative echocardiographic data of 40 children who underwent surgical closure of VSD were retrospectively reviewed. Left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), mitral valvular characteristics, including degree of MR and mitral valve annulus, and left atrial (LA) characteristics, including volume and dimensions, were observed. RESULTS Preoperative LVEDV, LVEDD, LVESD, mitral valvular annulus, LA volume, and LA dimensions were significantly larger in children with MR. Additionally, there were significant decreases in LVEDV, LVEDD, LA volume, and LA dimensions at one, three, and 12 months postoperatively. The degree of MR also improved to a lower grade after surgical closure of the VSD without additional mitral valve repair. CONCLUSION The echocardiographic parameters of left heart dilation and MR in children with VSD improved within the first year after surgical closure without additional mitral valve repair. Furthermore, in all of the patients with VSD, regardless of MR, LA dilation was reduced within three months after surgical closure of the VSD; however, LV and mitral valve annular dilatation decreased within 12 months.
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Affiliation(s)
- Hwa Jin Cho
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Jae Sook Ma
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Young Kuk Cho
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Byoung Hee Ahn
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Kook Joo Na
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea.
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Cho HJ, Ma JS, Cho YK, Ahn BH, Na KJ, Jeong IS. Timing in resolution of left heart dilation according to the degree of mitral regurgitation in children with ventricular septal defect after surgical closure. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2014. [DOI: 10.1016/j.jpedp.2013.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Jiang Z, Mei J, Ding F, Bao C, Zhu J, Tang M, Ma N, Huang J, Shen S. The early and mid-term results of mitral valve repair for mitral regurgitation in children. Surg Today 2013; 44:2086-91. [PMID: 24363116 DOI: 10.1007/s00595-013-0816-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 11/05/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE To review the surgical techniques and mid-term results of mitral valve repair in children with moderate or severe mitral regurgitation (MR). METHODS One hundred and seven children with moderate or severe MR, aged 19.6 ± 8.5 months, were enrolled in this study. The surgical techniques used for mitral valve repair varied according to the mitral valve morphology, and included annuloplasty, annuloplasty ring, cleft closure, reconstruction of the posterior leaflet, etc. The concomitant cardiac anomalies were treated simultaneously. The results of repair were evaluated by transesophageal echocardiography performed during the operation and by serial transthoracic echocardiography performed during the follow-up. RESULTS One hundred and six cases had no more than mild regurgitation intraoperatively, whereas only one case had moderate regurgitation. This patient underwent redo repair immediately, and the subsequent regurgitation was trivial. The in-hospital mortality rate was 0.9 % (1/107). The average follow-up was 46.5 ± 8.2 months. One patient died of heart failure 10 months postoperatively. The freedom from moderate or severe regurgitation after mitral valve repair was 92.3 ± 3.3 %. CONCLUSION Pediatric patients with moderate or severe MR require early surgical treatment. The early and mid-term results of mitral valve repair in pediatric patients were satisfactory.
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Affiliation(s)
- Zhaolei Jiang
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
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Mahadin DR, Srivastava S, Parness IA, Nguyen K, Love BA, Walsh R, Geiger MK, Nielsen JC. Outcomes of mitral regurgitation associated with large ventricular septal defect and a normal mitral valve apparatus: does intact atrial septum have an impact? Pediatr Cardiol 2011; 32:1128-31. [PMID: 21512787 DOI: 10.1007/s00246-011-9994-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 04/01/2011] [Indexed: 11/27/2022]
Abstract
The hemodynamics of isolated large ventricular septal defect with an intact atrial septum results in greater mitral valve (MV) annular dilation and an increased incidence of mitral regurgitation (MR). MR will resolve in most patients after surgical VSD closure alone without MV repair.
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Affiliation(s)
- Deemah R Mahadin
- Department of Pediatrics, Mount Sinai Medical School, Mount Sinai Children's Heart Center, One Gustave L. Levy Place, Box 1201, New York, NY 10029, USA
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Phan KP, Nguyen vP VP, Pham NV, Dao HT, Dang tT TTA, Le HD, Chu TH, Tri Ho HQ, Carpentier A. Mitral valve repair in children using Carpentier's techniques. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2001; 2:111-120. [PMID: 11486230 DOI: 10.1016/s1092-9126(99)70012-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Controversy remains regarding whether valve repair is preferable to valve replacement in children suffering from rheumatic mitral valve disease. To answer this question, 130 children aged 3 to 15 years (mean age, 11.8 +/- 2.8 years) undergoing surgery between January 1992 and December 1997 using Carpentier's techniques were reviewed. There were 111 cases of rheumatic valve diseases (85%), 17 cases of congenital mitral valve malformations (13%), one case of Barlow's syndrome (1%), and one case of bacterial endocarditis (1%). Valve dysfunction was classified into three types according to Carpentier's classification. There were 14 type II (leaflet prolapse), 78 type III (restricted leaflet motion), and 38 associated type II (anterior leaflet) and III (posterior leaflet) cases. There was one early (in-hospital) death (0.7%); the remaining 129 children were examined every 6 months. At the last examination, 99.2% of the patients were still alive, 96.8% were free of reoperation, and 89% showed no sign of significant residual stenosis or insufficiency on echocardiography. There have been no thromboembolisms. We conclude that mitral valve repair using Carpentier's techniques is the preferred procedure in the surgical treatment of mitral valve incompetence in children, even in those with rheumatic valvular disease. Copyright 1999 by W.B. Saunders Company
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Sugita T, Ueda Y, Matsumoto M, Ogino H, Nishizawa J, Matsuyama K. Early and late results of partial plication annuloplasty for congenital mitral insufficiency. J Thorac Cardiovasc Surg 2001; 122:229-33. [PMID: 11479494 DOI: 10.1067/mtc.2001.115157] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Partial plication annuloplasty is the main technique for congenital mitral insufficiency because this technique allows the mitral anulus to grow, in contrast to ring annuloplasty. However, this technique is not satisfactory for mitral insufficiency with some anomalies of the mitral valve apparatus. METHODS Forty-one patients underwent partial plication annuloplasty for mitral regurgitation from July 1979 to December 1998. Mitral regurgitation associated with an atrioventricular defect, an atrioventricular discordance, and a univentricular heart was excluded from this study. RESULTS There were no early or late deaths. In early results, partial plication annuloplasty was more effective for mitral regurgitation with abnormality of the posterior leaflet (n = 14) or normal leaflet motion (n = 8) than with abnormality of the anterior leaflet and its apparatus (n = 14) or absence of chordae (n = 4). The mean follow-up period was 145.8 months. During the follow-up period, 2 patients underwent mitral valve replacement, and a third patient underwent mitral valve repair with partial plication annuloplasty after the first repair. The main cause of mitral regurgitation of 2 of the 3 patients was absence of chordae. The actuarial freedom from reoperation rate was 94.9% +/- 3.6%, 91.9% +/- 4.7%, and 91.9% +/- 4.7% at 5, 10, and 15 years after the operation, respectively. CONCLUSION Early and long-term results of partial plication annuloplasty were acceptable for congenital mitral insufficiency with any type of malformation of the mitral valve, and results were excellent with abnormality of the posterior leaflet and its apparatus or normal leaflet motion. However, late results were suboptimal for mitral regurgitation with absence of chordae. Other techniques, such as artificial chorda replacement, should be adapted in these cases.
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Affiliation(s)
- T Sugita
- Department of Cardiovascular Surgery, Tenri Hospital, Nara, Japan
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15
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Ng CK, Nesser J, Punzengruber C, Pachinger O, Auer J, Franke H, Hartl P. Valvuloplasty with glutaraldehyde-treated autologous pericardium in patients with complex mitral valve pathology. Ann Thorac Surg 2001; 71:78-85. [PMID: 11216814 DOI: 10.1016/s0003-4975(00)02327-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Severe mitral regurgitation associated with complex mitral valve disease often precludes successful surgical repair. The feasibility and the results of valvuloplasty with glutaraldehyde-treated autologous pericardium remain largely unknown. METHODS The cases of 63 patients who underwent operation within an 11-year period were studied. A pretreated autologous pericardial patch was used for leaflet extension plasty, for paracommissural plasty, as a substitute for part of the leaflet, and for reimplantation of ruptured papillary muscles to eliminate severe mitral regurgitation. Patients with a severely calcified annulus after en bloc decalcification had straddling endoventricular pericardial patch annuloplasty for reconstruction of the affected atrioventricular groove. Chordal replacement with a strip of pericardium was chosen if no suitable chordae were available. Pericardium-reinforced suture annuloplasty was used in patients with acute endocarditis resistant to medical therapy. Associated valvuloplasty procedures with Carpentier techniques were also employed. RESULTS There were no operative deaths in this series. At a mean follow-up of 61.1 months (range, 4 to 132 months), mitral regurgitation was absent or trivial in 92.1% of patients by echocardiography. Freedom from reoperation was 95.2% at 1 year and 5 years. Thromboembolic events have not been detected. Thirty percent of patients returned to sinus rhythm. Two patients required valve replacement. CONCLUSIONS Our beneficial results indicate that glutaraldehyde-treated autologous pericardium is suitable for valvuloplasty. It provides durable and predictable repair of valves that might otherwise need to be replaced because of the complex mitral valve disease. The technique is reliable, allows further efficacious repair possibilities, and improves postoperative outcomes. Whether it can prevent late deterioration and calcification requires more investigation.
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Affiliation(s)
- C K Ng
- Department of Cardiovascular Surgery, General Hospital Wels, Austria.
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Ohno H, Imai Y, Terada M, Hiramatsu T. The long-term results of commissure plication annuloplasty for congenital mitral insufficiency. Ann Thorac Surg 1999; 68:537-41. [PMID: 10475425 DOI: 10.1016/s0003-4975(99)00515-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Mitral valve repair in the pediatric population remains demanding because of a diversity of apparatus anomalies and the young age of the patients. METHODS We reviewed our clinical results for mitral valve repairs for congenital mitral insufficiency. Forty-nine consecutive patients aged 2 months to 34 years (mean, 4.4 years) had mitral valve repair between June 1984 and December 1996. Forty-one patients (83.7%) had associated cardiac anomalies. The predominant pathologies for the regurgitations were chordal anomalies in 34 patients (69%), annular dilatation in 8 (16%), and leaflet anomalies in 7 (14%). Mitral valve repair included commissure plication annuloplasty in 43 patients (88%), modified DeVega in 11, cleft closure in 5, plication of the anterior leaflet in 3, triangular resection of the anterior leaflet in 2, chordal shortening in 1, and placement of artificial chordae in 1. Several combined techniques were required in 19 patients. RESULTS There were no early or late deaths. The follow-up period was from 6 to 166 months (mean, 88.4 months). Forty-seven patients (95.9%) were in New York Heart Association class I. The long-term echocardiographic studies showed that 2 of 30 patients without reoperation had moderate regurgitation. The actuarial freedom from reoperation was 85.6% (95% confidence limits, 72.8%, 98.4%) at 13 years. Five patients (10.2%) required valve replacement from 13 days to 75 months after the valve repair. Two patients had cerebral ischemic events as a result of cardiomegaly and atrial fibrillation. CONCLUSIONS Valve repair for congenital mitral insufficiency gave adequate results in combination with commissure plication annuloplasty and other techniques with excellent long-term functional status.
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Affiliation(s)
- H Ohno
- Department of Pediatric Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University.
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Tanaka K, Yasunaga H, Egashira A, Kumate M, Kawara T, Kosuga K. [Aneurysm of the membranous ventricular septum with ventricular septal defect, mitral and tricuspid insufficiency]. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 1998; 46:1009-13. [PMID: 9847579 DOI: 10.1007/bf03217864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A seventy-year-old man was admitted at our hospital because of dyspnea. Echocardiogram and left ventriculogram showed an aneurysm formation of the membranous ventricular septum and small left-to-right shunt through ventricular septum defect and also severe mitral and tricuspid insufficiency. Operation was performed after medical therapy for congestive heart failure. During operation, mitral leaflets showed no organic lesions nor prolapse, but the annulus was dilated. The cause of mitral insufficiency, we thought, might be congenital, and the annulus dilatation was caused of mitral insufficiency, we thought, might be congenital, and the annulus dilatation was caused to produce tricuspid insufficiency secondary. The ventricular septal communication became small (diameter; 5 mm) and was associated with aneurysm formation of the remaining portion of the membranous septum. And the aneurysm, protruding to the septal leaflet of tricuspid valves, enhanced tricuspid insufficiency. It was reported by many authors that the aneurysm formation was related to spontaneous closure of ventricular septal defect. Patients with small ventricular septal defect, without any symptoms, must be followed intensively, or they might get cardiac complications, such as arrhythmia, right ventricular outflow obstruction, tricuspid insufficiency, and so on.
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Affiliation(s)
- K Tanaka
- Division of Cardiovascular Surgery, Munakata Suikokai General Hospital, Fukuoka, Japan
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