1
|
Trisauvapak T, Bongkotwilawan N, Ekawaravong S. Challenges of managing anomalous mitral arcade with severe mitral regurgitation and hydrops fetalis in infants. BMJ Case Rep 2024; 17:e259272. [PMID: 38866580 PMCID: PMC11177271 DOI: 10.1136/bcr-2023-259272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/14/2024] Open
Abstract
Anomalous mitral arcade (MA) is a rare congenital anomaly. We report a case of MA in a newborn who presented with hydrops fetalis due to severe mitral regurgitation. After birth, he developed severe respiratory failure, congestive heart failure and airway obstruction because an enlarged left atrium from severe mitral regurgitation compressed the distal left main bronchus. There is limited experience in surgical management of this condition in Thailand, and the patient's mitral valve was too small for replacement. Therefore, he was treated with medication to control heart failure and supported with positive pressure ventilation to promote growth. We have followed the patient until the current time of writing this report at the age of 2 years, and his outcome is favourable regarding heart failure symptoms, airway obstruction, growth and development. This case describes a challenging experience in the non-surgical management of MA with severe regurgitation, which presented at birth.
Collapse
Affiliation(s)
- Tienake Trisauvapak
- Pediatrics, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Bang phli, Thailand
| | - Nitiroj Bongkotwilawan
- Pediatrics, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Bang phli, Thailand
| | - Suparat Ekawaravong
- Pediatrics, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Bang phli, Thailand
| |
Collapse
|
2
|
Zhang QL, Chen YK, Lin SH, Du XW, Chen Q, Wang SM, Cao H. Tricuspid mechanical valve replacement for severe tricuspid stenosis in a child who underwent surgical correction of complete atrioventricular septal defect, a rare long-term complications. J Cardiothorac Surg 2024; 19:77. [PMID: 38336747 PMCID: PMC10858579 DOI: 10.1186/s13019-024-02580-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Complete atrioventricular septal defect is a complicated congenital heart malformations, and surgical correction is the best treatment, the severe tricuspid stenosis is a rare long-term complication after the surgery. CASE PRESENTATION We report a case with the complication of severe tricuspid stenosis 7 years after the surgical correction of complete atrioventricular septal defect in a child. Then the patient underwent tricuspid mechanical valve replacement, Glenn, atrial septostomy, and circumconstriction of the right pulmonary artery. CONCLUSIONS The patient recovered successfully with good short-term.
Collapse
Affiliation(s)
- Qi-Liang Zhang
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Yu-Kun Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shi-Hao Lin
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xin-Wei Du
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Shun-Min Wang
- Department of Cardiac and Thoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
| |
Collapse
|
3
|
Overman DM, Moga FX, Stephens EH, Dearani JA, MacIver RH. Infant Mitral Valve Replacement: Current State of the Art. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2023; 26:75-80. [PMID: 36842801 DOI: 10.1053/j.pcsu.2023.01.001] [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: 11/07/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023]
Abstract
Mitral valve replacement (MVR) in the very young is an imposing clinical challenge. Early and late mortality risk is substantial, severe adverse events are common, and redo mitral valve replacement is inevitable. Therapeutic options are limited. In the older infant with an annulus of 17mm or larger, mechanical MVR is associated with low risk of mortality and predictable durability. For the very young with annular hypoplasia, bovine jugular vein conduit MVR appears to offer equivalent or better early outcomes with the possibility of subsequent valve expansion, potentially prolonging the interval to redo MVR. Experience with cylinder MVR and other forms of surgeon-manufactured MVR is quite limited, and there is currently no information on late outcomes or durability.
Collapse
Affiliation(s)
- David M Overman
- Division of Cardiac Surgery, The Children's Heart Clinic and Children's Minnesota, Minneapolis, MN, USA; Division of Cardiovascular Surgery, Children's Minnesota, Minneapolis, MN, USA; Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, MN, USA.
| | - Francis X Moga
- Division of Cardiac Surgery, The Children's Heart Clinic and Children's Minnesota, Minneapolis, MN, USA; Division of Cardiovascular Surgery, Children's Minnesota, Minneapolis, MN, USA; Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, MN, USA
| | - Elizabeth H Stephens
- Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, MN, USA; Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph A Dearani
- Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, MN, USA; Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Robroy H MacIver
- Division of Cardiac Surgery, The Children's Heart Clinic and Children's Minnesota, Minneapolis, MN, USA; Division of Cardiovascular Surgery, Children's Minnesota, Minneapolis, MN, USA; Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Rochester, MN, USA
| |
Collapse
|
4
|
Yoneyama F, Imamura M. Modified atrioventricular valve replacement in children. J Card Surg 2022; 37:3325-3327. [PMID: 35830724 DOI: 10.1111/jocs.16775] [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: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 11/29/2022]
Abstract
One major challenge of atrioventricular valve replacement in children is the small size of the native valve annulus. In addition, in cases of atrioventricular septal defect, the atrioventricular node (AVN) shifts to a different location, making this condition difficult to treat. This report describes a technique that uses a trapezoid-shaped patch to separate the implanted valve suture-line from the AVN, which allows surgeons to implant larger valves while simultaneously preventing injury to the AVN.
Collapse
Affiliation(s)
- Fumiya Yoneyama
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Michiaki Imamura
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|