Mitral valve repair using leaflet expansion and subpartial annuloplasty in children.

Autor:	Wierup P; Department of Pediatric Heart Surgery, Skane University Hospital, Lund, Sweden.; Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden., Ramgren JJ; Department of Pediatric Heart Surgery, Skane University Hospital, Lund, Sweden., Sjögren J; Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden., Phan KT; Department of Pediatric Heart Surgery, Skane University Hospital, Lund, Sweden., Zindovic I; Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden., Nozohoor S; Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden., Christierson L; Department of Pediatric Cardiology, Skane University Hospital, Lund, Sweden.; Department of Biomedical Engineering, Lund University, Lund, Sweden., Hakacova N; Department of Pediatric Cardiology, Skane University Hospital, Lund, Sweden.
Jazyk:	angličtina
Zdroj:	JTCVS techniques [JTCVS Tech] 2023 Oct 30; Vol. 23, pp. 74-80. Date of Electronic Publication: 2023 Oct 30 (Print Publication: 2024).
DOI:	10.1016/j.xjtc.2023.10.020
Abstrakt:	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. Competing Interests: Dr Wierup is a consultant for Medtronic, CryoLife, Edwards Lifescience, and Bristol Myers Squib. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. (© 2023 The Author(s).)
Databáze:	MEDLINE
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