Mitral valve repair using leaflet expansion and subpartial annuloplasty in children
(2024) In JTCVS Techniques 23. p.74-80- Abstract
Objective: Mitral valve reconstruction in the pediatric population is a challenge due to the frequent combination of annular dilatation and leaflet restriction and the need for growth. We present a novel strategy using leaflet expansion and subpartial annuloplasty with polytetrafluoroethylene reinforcement. Methods: From January 2014 through May 2021, 11 children aged 5 months to 14 years (median, 24 months) underwent elective mitral valve repair due to severe mitral valve regurgitation. The mitral valve abnormalities included congenital malformations (n = 7), postoperative leakage following commissurotomy (n = 1), and functional mitral valve regurgitation due to dilated cardiomyopathy (n = 3). Surgery consisted of leaflet expansions... (More)
Objective: Mitral valve reconstruction in the pediatric population is a challenge due to the frequent combination of annular dilatation and leaflet restriction and the need for growth. We present a novel strategy using leaflet expansion and subpartial annuloplasty with polytetrafluoroethylene reinforcement. Methods: From January 2014 through May 2021, 11 children aged 5 months to 14 years (median, 24 months) underwent elective mitral valve repair due to severe mitral valve regurgitation. The mitral valve abnormalities included congenital malformations (n = 7), postoperative leakage following commissurotomy (n = 1), and functional mitral valve regurgitation due to dilated cardiomyopathy (n = 3). Surgery consisted of leaflet expansions with autologous, untreated pericardium and subpartial annuloplasty with polytetrafluoroethylene reinforcement. Results: All children survived their surgeries with uneventful postoperative courses, except for 1 patient who needed an early reoperation to resolve a functional stenosis due to a spinnaker phenomenon. At discharge, mean gradient was 3.5 ± 3.9 mm Hg, with trivial mitral regurgitation in 9 patients (82%). All patients were alive and asymptomatic during the median follow-up of 3 years (range, 1-7 years). Their echocardiographic data showed a mean transmitral gradient of 4.4 ± 1.7 mm Hg and remained unchanged. Residual mitral valve regurgitation was trivial or mild in 9 patients (82%) and moderate in 2 patients (18%). Conclusions: Leaflet expansion with autologous pericardium and subpartial annuloplasty with polytetrafluoroethylene reinforcement for mitral regurgitation in the pediatric population gives stable and satisfactory results both early and at intermediate follow-up, permitting growth of the mitral valve.
(Less)
- author
- Wierup, Per LU ; Ramgren, Jens Johansson LU ; Sjögren, Johan LU ; Phan, Kiet Tran ; Zindovic, Igor LU ; Nozohoor, Shahab LU ; Christierson, Lea LU and Hakacova, Nina LU
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- congenital, leaflet expansion, mitral regurgitation, neochordae, pediatric
- in
- JTCVS Techniques
- volume
- 23
- pages
- 74 - 80
- publisher
- Elsevier
- external identifiers
-
- pmid:38351986
- scopus:85179490984
- ISSN
- 2666-2507
- DOI
- 10.1016/j.xjtc.2023.10.020
- language
- English
- LU publication?
- yes
- id
- 24d1b801-5dcf-4f6b-b6a6-340ec5ac6d3d
- date added to LUP
- 2024-01-11 11:39:54
- date last changed
- 2024-11-09 04:54:33
@article{24d1b801-5dcf-4f6b-b6a6-340ec5ac6d3d,
abstract = {{<p>Objective: Mitral valve reconstruction in the pediatric population is a challenge due to the frequent combination of annular dilatation and leaflet restriction and the need for growth. We present a novel strategy using leaflet expansion and subpartial annuloplasty with polytetrafluoroethylene reinforcement. Methods: From January 2014 through May 2021, 11 children aged 5 months to 14 years (median, 24 months) underwent elective mitral valve repair due to severe mitral valve regurgitation. The mitral valve abnormalities included congenital malformations (n = 7), postoperative leakage following commissurotomy (n = 1), and functional mitral valve regurgitation due to dilated cardiomyopathy (n = 3). Surgery consisted of leaflet expansions with autologous, untreated pericardium and subpartial annuloplasty with polytetrafluoroethylene reinforcement. Results: All children survived their surgeries with uneventful postoperative courses, except for 1 patient who needed an early reoperation to resolve a functional stenosis due to a spinnaker phenomenon. At discharge, mean gradient was 3.5 ± 3.9 mm Hg, with trivial mitral regurgitation in 9 patients (82%). All patients were alive and asymptomatic during the median follow-up of 3 years (range, 1-7 years). Their echocardiographic data showed a mean transmitral gradient of 4.4 ± 1.7 mm Hg and remained unchanged. Residual mitral valve regurgitation was trivial or mild in 9 patients (82%) and moderate in 2 patients (18%). Conclusions: Leaflet expansion with autologous pericardium and subpartial annuloplasty with polytetrafluoroethylene reinforcement for mitral regurgitation in the pediatric population gives stable and satisfactory results both early and at intermediate follow-up, permitting growth of the mitral valve.</p>}},
author = {{Wierup, Per and Ramgren, Jens Johansson and Sjögren, Johan and Phan, Kiet Tran and Zindovic, Igor and Nozohoor, Shahab and Christierson, Lea and Hakacova, Nina}},
issn = {{2666-2507}},
keywords = {{congenital; leaflet expansion; mitral regurgitation; neochordae; pediatric}},
language = {{eng}},
pages = {{74--80}},
publisher = {{Elsevier}},
series = {{JTCVS Techniques}},
title = {{Mitral valve repair using leaflet expansion and subpartial annuloplasty in children}},
url = {{http://dx.doi.org/10.1016/j.xjtc.2023.10.020}},
doi = {{10.1016/j.xjtc.2023.10.020}},
volume = {{23}},
year = {{2024}},
}