Dou Zheng,Mao Fengqun,Ma Kai,et al.Intraoperative findings and mid-term outcomes of standardized repair for isolated mitral regurgitation in children[J].Journal of Clinical Pediatric Surgery,,():615-619.[doi:10.3760/cma.j.cn101785-202406039-003]
Intraoperative findings and mid-term outcomes of standardized repair for isolated mitral regurgitation in children
- Keywords:
- Congenital Heart Disease; Isolated Mitral Regurgitation; Surgical Procedures; Operative; Child
- Abstract:
- Objective To preliminarily investigate the etiological characteristics of isolated mitral regurgitation in children,intraoperative findings,and mid-term follow-up outcomes after standardized mitral valve repair.Methods A retrospective analysis was conducted on 42 cases of isolated mitral regurgitation in children who underwent standardized mitral valve repair at the Pediatric Cardiac Surgery Center,Fuwai Hospital,Chinese Academy of Medical Sciences,from January 2020 to December 2023.There were 16 males and 26 females with a median age at surgery of 76.1 (range:45.2 to 109.1) months.The primary endpoints were all-cause mortality and mitral valve dysfunction,and the secondary endpoints were severe perioperative complications.Results Intraoperative exploration revealed that,besides annular dilation,the most common anatomical cause of isolated mitral regurgitation was subvalvular deformity,observed in 39 cases (39/42,92.9%).During a median follow-up of 17.1 (range:11.9 to 23.7) months,there were no severe perioperative complications or deaths.Three patients developed significant mitral regurgitation postoperatively,among whom 2 underwent mechanical mitral valve replacement,while 1 continues under medical management.A preoperative and follow-up self-comparison was conducted on the 40 patients who did not undergo mechanical valve replacement.The results showed that postoperative left ventricular ejection fraction and left ventricular end-diastolic diameter were significantly lower than preoperative values (P<0.05),and the severity of mitral regurgitation was significantly improved compared to preoperative levels (Z=-5.715,P<0.05).The rates of freedom from major endpoint events at 6 months,1 year,and 3 years postoperatively were 97.62%,95.05%,and 81.47%,respectively.Conclusions Anatomical abnormalities causing isolated mitral regurgitation predominantly involve subvalvular structures.Subvalvular exploration and management are crucial technical aspects of mitral valve repair.
References:
[1] Kulyabin YY,Soynov IA,Zubritskiy AV,et al.Does mitral valve repair matter in infants with ventricular septal defect combined with mitral regurgitation?[J].Interact Cardiovasc Thorac Surg,2018,26(1):106-111.DOI:10.1093/icvts/ivx231.
[2] 范明,莫绪明,陈俊,等.小儿二尖瓣关闭不全瓣膜成形术的临床疗效分析[J].临床小儿外科杂志,2020,19(6):513-517.DOI:10.3969/j.issn.1671-6353.2020.06.010. Fan M,Mo XM,Chen J,et al.Clinical efficacy of mitral valve insufficiency reconstruction in children[J].DOI:10.3969/j.issn.1671-6353.2020.06.010.
[3] Qi L,Ma K,Zhang BQ,et al.Pediatric mitral regurgitation:standardized repair-oriented strategy with leaflet plication[J].Semin Thorac Cardiovasc Surg,2020,32(4):1002-1012.DOI:10.1053/j.semtcvs.2020.05.029.
[4] Hahn RT,Abraham T,Adams MS,et al.Guidelines for performing a comprehensive transesophageal echocardiographic examination:recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists[J].J Am Soc Echocardiogr,2013,26(9):921-964.DOI:10.1016/j.echo.2013.07.009.
[5] Ma K,He QY,Dou Z,et al.Current treatment outcomes of congenital heart disease and future perspectives[J].Lancet Child Adolesc Health,2023,7(7):490-501.DOI:10.1016/S2352-4642(23)00076-7.
[6] Iddawela S,Joseph PJS,Ganeshan R,et al.Paediatric mitral valve disease-from presentation to management[J].Eur J Pediatr,2022,181(1):35-44.DOI:10.1007/s00431-021-04208-7.
[7] Mayr B,Vitanova K,Burri M,et al.Mitral valve repair in children below age 10 years:trouble or success?[J].Ann Thorac Surg,2020,110(6):2082-2087.DOI:10.1016/j.athoracsur.2020.02.057.
[8] Vida VL,Zanotto L,Carrozzini M,et al.Repair techniques for mitral valve insufficiency in children[J].Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu,2018,21:41-45.DOI:10.1053/j.pcsu.2017.11.004.
[9] Samad Z,Shaw LK,Phelan M,et al.Long-term outcomes of mitral regurgitation by type and severity[J].Am Heart J,2018,203:39-48.DOI:10.1016/j.ahj.2018.05.001.
[10] Kalfa D,Vergnat M,Ly M,et al.A standardized repair-oriented strategy for mitral insufficiency in infants and children:midterm functional outcomes and predictors of adverse events[J].J Thorac Cardiovasc Surg,2014,148(4):1459-1466.DOI:10.1016/j.jtcvs.2014.02.057.
[11] Vricella LA,Ravekes WA,Arbustini E,et al.Simplified mitral valve repair in pediatric patients with connective tissue disorders[J].J Thorac Cardiovasc Surg,2017,153(2):399-403.DOI:10.1016/j.jtcvs.2016.09.039.
[12] Bitterman AD,Sponseller PD.Marfan syndrome:a clinical update[J].J Am Acad Orthop Surg,2017,25(9):603-609.DOI:10.5435/JAAOS-D-16-00143.
[13] Lawrie GM.Barlow disease:simple and complex[J].J Thorac Cardiovasc Surg,2015,150(5):1078-1081.DOI:10.1016/j.jtcvs.2015.09.030.
[14] Borger MA,Kaeding AF,Seeburger J,et al.Minimally invasive mitral valve repair in Barlow’s disease:early and long-term results[J].J Thorac Cardiovasc Surg,2014,148(4):1379-1385.DOI:10.1016/j.jtcvs.2013.11.030.
Memo
收稿日期:2024-6-21。
基金项目:中央高水平医院临床科研业务费(2022-GSP-GG-19);北京市科技计划(Z201100005520001)
通讯作者:李守军,Email:drlishoujunfw@163.com