Mitral valve repair using leaflet expansion and subpartial annuloplasty in childrenCentral MessagePerspective
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 reinfo...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250723004005 |
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| author | Per Wierup, MD, PhD Jens Johansson Ramgren, MD, PhD Johan Sjögren, MD, PhD Kiet Tran Phan, MD, PhD Igor Zindovic, MD, PhD Shahab Nozohoor, MD, PhD Lea Christierson, MSc Nina Hakacova, MD, PhD |
| author_facet | Per Wierup, MD, PhD Jens Johansson Ramgren, MD, PhD Johan Sjögren, MD, PhD Kiet Tran Phan, MD, PhD Igor Zindovic, MD, PhD Shahab Nozohoor, MD, PhD Lea Christierson, MSc Nina Hakacova, MD, PhD |
| author_sort | Per Wierup, MD, PhD |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-cff65cf0be914dee88a5be61d568aedc |
| institution | DOAJ |
| issn | 2666-2507 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-cff65cf0be914dee88a5be61d568aedc2025-08-20T03:04:53ZengElsevierJTCVS Techniques2666-25072024-02-0123748010.1016/j.xjtc.2023.10.020Mitral valve repair using leaflet expansion and subpartial annuloplasty in childrenCentral MessagePerspectivePer Wierup, MD, PhD0Jens Johansson Ramgren, MD, PhD1Johan Sjögren, MD, PhD2Kiet Tran Phan, MD, PhD3Igor Zindovic, MD, PhD4Shahab Nozohoor, MD, PhD5Lea Christierson, MSc6Nina Hakacova, MD, PhD7Department of Pediatric Heart Surgery, Skane University Hospital, Lund, Sweden; Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden; Address for reprints: Per Wierup, MD, PhD, Departments of Pediatric Heart Surgery and Cardiothoracic Surgery, Skane University Hospital, 22185 Lund, Sweden.Department of Pediatric Heart Surgery, Skane University Hospital, Lund, SwedenDepartment of Cardiothoracic Surgery, Skane University Hospital, Lund, SwedenDepartment of Pediatric Heart Surgery, Skane University Hospital, Lund, SwedenDepartment of Cardiothoracic Surgery, Skane University Hospital, Lund, SwedenDepartment of Cardiothoracic Surgery, Skane University Hospital, Lund, SwedenDepartment of Pediatric Cardiology, Skane University Hospital, Lund, Sweden; Department of Biomedical Engineering, Lund University, Lund, SwedenDepartment of Pediatric Cardiology, Skane University Hospital, Lund, SwedenObjective: 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.http://www.sciencedirect.com/science/article/pii/S2666250723004005congenitalmitral regurgitationleaflet expansionpediatricneochordae |
| spellingShingle | Per Wierup, MD, PhD Jens Johansson Ramgren, MD, PhD Johan Sjögren, MD, PhD Kiet Tran Phan, MD, PhD Igor Zindovic, MD, PhD Shahab Nozohoor, MD, PhD Lea Christierson, MSc Nina Hakacova, MD, PhD Mitral valve repair using leaflet expansion and subpartial annuloplasty in childrenCentral MessagePerspective JTCVS Techniques congenital mitral regurgitation leaflet expansion pediatric neochordae |
| title | Mitral valve repair using leaflet expansion and subpartial annuloplasty in childrenCentral MessagePerspective |
| title_full | Mitral valve repair using leaflet expansion and subpartial annuloplasty in childrenCentral MessagePerspective |
| title_fullStr | Mitral valve repair using leaflet expansion and subpartial annuloplasty in childrenCentral MessagePerspective |
| title_full_unstemmed | Mitral valve repair using leaflet expansion and subpartial annuloplasty in childrenCentral MessagePerspective |
| title_short | Mitral valve repair using leaflet expansion and subpartial annuloplasty in childrenCentral MessagePerspective |
| title_sort | mitral valve repair using leaflet expansion and subpartial annuloplasty in childrencentral messageperspective |
| topic | congenital mitral regurgitation leaflet expansion pediatric neochordae |
| url | http://www.sciencedirect.com/science/article/pii/S2666250723004005 |
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