Durability of Mitral Valve Repair Performed Before the Age of 5 Years

Ando, Motomi; Takahashi, Yukihiro

doi:10.1253/circj.cj-15-0372

Cited by 13 publications

(3 citation statements)

References 29 publications

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“…In patients with Carpentier's type 1 mitral valve malformation, the lesions were localized, and surgical outcomes were satisfactory by minimally invasive methods, such as Kay-Reed's annuloplasty and cleft suture, which has also been previously reported. 4,21,22 However, in patients with a large cleft reaching the annular ring (such as in case 2), performing only cleft suture could influence the valve leaflet dimensions and worsen the mitral regurgitation. Therefore, patch augmentation seems to be a better choice for these patients.…”

Section: Commentmentioning

confidence: 99%

Congenital Mitral Regurgitation Repair Based on Carpentier's Classification: Long-Term Outcomes

Miwa

Iwai

Kanaya

et al. 2023

World J Pediatr Congenit Heart Surg

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Background There are few reports of the outcomes of standardized surgical management addressing the etiologic and morphologic aspects of mitral valve malformation according to Carpentier's classification. This study aimed to evaluate the long-term outcomes of mitral valve repair in children according to Carpentier's classification. Methods Patients who underwent mitral valve repair at our institution between 2000 and 2021 were retrospectively reviewed. Preoperative data, surgical techniques, and outcomes were analyzed according to Carpentier's classification. The proportion of patients free of mitral valve replacement and reoperation was estimated using Kaplan-Meier analysis. Results Twenty-three patients (median operative age, four months) were followed up for 10 (range, 2-21) years. Preoperative mitral regurgitation was severe in 12 patients and moderate in 11 patients. Eight, five, seven, and three patients had Carpentier's type 1, 2, 3, and 4 lesions, respectively. Ventricular septal defect (N = 9) and double outlet of the great arteries from the right ventricle (N = 3) were the most commonly associated cardiac malformations. There were no cases of operative mortality or deaths during the follow-up. The overall five-year rate of freedom from mitral valve replacement was 91%, whereas the five-year rates of freedom from reoperation were 74%, 80%, 71%, and 67% in type 1, 2, 3, and 4 lesions, respectively. Postoperative mitral regurgitation at the last follow-up was moderate in three patients and less than mild in 20 patients. Conclusions Current surgical management of congenital mitral regurgitation is generally considered adequate; however, more complicated cases required a combination of various surgical techniques.

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Section: Commentmentioning

confidence: 99%

Congenital Mitral Regurgitation Repair Based on Carpentier's Classification: Long-Term Outcomes

Miwa

Iwai

Kanaya

et al. 2023

World J Pediatr Congenit Heart Surg

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“…Scientific evidence in children is not sufficient regarding how many times repair is feasible or how promising are the long-term results. 99, [1058][1059][1060] Regular follow-up on echocardiography is mandatory; stenosis or regurgitation can recur and progress in childhood or even after reaching adulthood.…”

Section: Mitral Stenosis and Regurgitationmentioning

confidence: 99%

JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair

Ohuchi

Kawata²,

Uemura

et al. 2022

Circ J

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9JCS 2022 Guideline on Management/Re-Intervention in ACHD comorbidity, 172 and cardiac catheterization is fundamental for its evaluation. 173 ▋ 3.4.4 Left Heart Catheterization and Coronary Angiography Echocardiography, CT, and MRI are often substituted for left ventriculography, aortography, or coronary angiography. CT precisely illustrates abnormal origins and courses of the coronary arteries in many cases, which is why coronary angiography is not recommended as a routine examination (Class III). In some patients, nonetheless, coronary angiography is quite informative beyond CT resolution; for example, anastomotic stenosis at the coronary arterial origin would be better demonstrated by catheter angiography after the arterial switch procedure. 174 ▋ 3.4.5 Endomyocardial Biopsy Endomyocardial biopsy is rarely required in patients with postoperative CHD. ▋ 3.4.6 Catheter InterventionTranscatheter closure of atrial septal defect or patent ductus arteriosus is carried out routinely in the cardiac catheterization room, as is percutaneous pulmonary angioplasty. Interventional closure of ventricular septal defect needs more evidence before becoming established in Japan.Transcatheter pulmonary valve replacement will be introduced in the near future.Electrophysiological study and catheter ablation are common practices for arrhythmias in the CHD field. Recent advances in technology and devices, such as 3D mapping systems, have contributed to notable results in anti-arrythmic treatments in patients with repaired CHD. 175

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“…[5][6][7][8][9][10][11][12][13][14][15] Larger series have consisted of postmortem studies or have included patients who have additional cardiac defects. [16][17][18][19] An early, small surgical case series reported repair of isolated MVC via direct suturing or a pericardial patch in four patients. 20 All patients in our surgical cohort underwent suture repair of the MVC, irrespective of surgical approach (median sternotomy or robot-assisted minimally invasive), similar to more recent series.…”

Section: Commentmentioning

confidence: 99%

Management of Isolated, Congenital Anterior Mitral Valve Cleft

Hargiss

Dearani

Taggart

2021

World J Pediatr Congenit Heart Surg

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Background: Isolated anterior mitral valve clefts (MVC) are rare congenital heart defects, and data are limited regarding the natural history and surgical outcomes for such isolated MVCs. Methods: We conducted a retrospective review of patients with congenital MVC who were evaluated at Mayo Clinic in Rochester, Minnesota between 1993 and 2020. Patients were separated into two cohorts: those who underwent surgical repair of the MVC and those who had not yet undergone repair. Baseline and postoperative clinical and echocardiographic data were analyzed. Results: Fourteen patients were included in the nonsurgical cohort and eight patients in the surgical cohort. Surgical repair was via primary median sternotomy (n = 6) or robot-assisted, minimally invasive (n = 2). All cleft repairs were performed by simple suture closure. Intraoperative evaluation of the clefts did not reveal additional structural factors that could account for the mitral regurgitation (MR). At latest follow-up of the surgical cohort, the median grade of MR was 1 (range 0-1), and median left ventricular ejection fraction was 65% (IQR 59%-67%), both similar to the immediate postoperative result. At latest follow-up, all patients in the nonsurgical cohort were NYHA Class 1, and median MR grade was 1. All patients were asymptomatic (NYHA Class 1). Conclusions: Our findings corroborate prior reports that MVC repair is safe and successful and is followed by a low rate of recurrent mitral valve dysfunction. Durable surgical repair of isolated, congenital MVC can be performed safely in select patients. The decision to intervene should be based on the severity of mitral regurgitation and patient symptoms rather than the presence of the MVC alone.

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Durability of Mitral Valve Repair Performed Before the Age of 5 Years

Cited by 13 publications

References 29 publications

Congenital Mitral Regurgitation Repair Based on Carpentier's Classification: Long-Term Outcomes

Congenital Mitral Regurgitation Repair Based on Carpentier's Classification: Long-Term Outcomes

JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair

Management of Isolated, Congenital Anterior Mitral Valve Cleft

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