Mid-Term Follow-Up of Neonatal Neochordal Reconstruction of Tricuspid Valve for Perinatal Chordal Rupture Causing Severe Tricuspid Valve Regurgitation

Abstract

Background: Papillary muscle rupture in the perinatal period is a rare event that leads to severe mitral or tricuspid insufficiency due to a flail leaflet. Neonatal tricuspid chordal reconstruction for this condition is rarely reported. Early recognition and treatment have the potential to be lifesaving. We present our surgical experience with five such patients, along with their midterm follow-up. Methods: Between August 2010 and November 2012, five neonates (aged 1-30 days) underwent surgery for severe atrioventricular valve regurgitation. All neonates had severe tricuspid regurgitation due to ruptured chordae. In addition, two had moderate mitral regurgitation; one due to ruptured chordae of the posterior mitral leaflet and the other due to prolapse of the anterior mitral leaflet. All underwent emergent surgery where the ruptured chordae to the anterior tricuspid leaflet were replaced with neochordae made with expanded polytetrafluoroethylene (ePTFE) suture. The mitral valve was repaired in two patients. Results: All patients survived surgery without the need for postoperative mechanical circulatory assist. Predischarge echocardiograms showed good coaptation of tricuspid and mitral leaflets with minimal regurgitation in all. At follow-up between 75 months to 102 months, four patients had excellent outcomes with less than mild tricuspid regurgitation. One child with flail tricuspid and mitral leaflets developed progressive tricuspid and mitral regurgitation requiring surgical re-repair at 20 months following the initial surgery. Conclusion: Repair of chordal rupture of the tricuspid valve in neonates using e PTFE neo-chordae can provide acute salvage and gratifying midterm results in the management of this potentially fatal condition.

Case Report: unexpected cause of cyanosis in an infant after acute exposure to high altitude—severe tricuspid regurgitation secondary to tricuspid valve prolapse

“…With scarce published in the pediatric population, TVP tends to be a forgotten mechanism of cyanosis in children. To the best of our knowledge, TVP-induced cyanosis has merely been observed in neonatal patients with or without congenital heart anomalies (26 reported cases), whose pulmonary vascular resistances have not yet fallen to adult levels, thus facilitating severe TR and the right to left shunting through PFO (13,(22)(23)(24)(25). However, our case emphasized this phenomenon could also be found even in previously healthy infants after environmental exposure predisposing to TVP.…”

Diagnosis and intervention of severe tricuspid regurgitation secondary to rupture of the chordae tendineae: A case report and literature review

“…Long-term follow-up is rarely reported. Chowdhuri et al ( 17 ) reported five cases with a median follow-up of 89 months. All five patients grew normally during follow-up and had either trivial or mild TR with good coaptation of the TV at the last visit.…”

Neonatal Rupture of the Tricuspid Valve and Maternal Lupus: Is There a Correlation?

“…Although there is scarce data regarding to repair of chordal rupture of the TV in neonates, some authors advocated that the use of expanded polytetrafluoroethylene neochordae provided satisfactory midterm results. 5 However, other authors did not use this material and directly reattached the avulsed papillary muscle to the ventricular myocardium using a suture with autologous pericardial pledgets to reinforce the reattached papillary muscle, achieving satisfactory results as well. 6 In our patient, it was the surgeon's choice to create a neo-papillary muscle from the RV trabeculae and to directly attach it to the edge of the tricuspid leaflet without creating any neochordae.…”