Leaflet foldoplasty of mitral valvuloplasty for mitral regurgitation in children_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QI Lei , MA Kai , ZHANG Benqing , PANG Kunjing , MAO Fengqun , ZHANG Sen , WANG Guanxi , FENG Zicong , YANG Yang , YUAN Jianhui ,  LI Shoujun

Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

LI Shoujun, Email: drlishoujun@yahoo.com

Keywords：

Congenital mitral regurgitation; mitral valvuloplasty; leaflet foldoplasty; standardized strategy

DOI：

10.7507/1007-4848.202003032

Video：

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Objective To report the short-term outcomes of a standardized, simplified and reproducible strategy of mitral valvuloplasty (MVP), which was focused on leaflet foldoplasty and anatomic anomalies of congenital mitral regurgitation (MR).Methods Consecutive 74 patients who underwent MVP by our standardized strategy in our institution from 2016 to 2018 were included retrospectively. There were 30 males and 44 females with a median age of 18.5 (6-146) months and weight of 15.4 (7-51) kg.Results Anatomic anomalies of MR included: (1) subvalvular apparatus: 72 (97.3%) patients with mal-connected chordae tendineae, 31 (41.9%) with absent chordae tendineae and 14 (18.9%) with fused or dysplastic papillary muscle; (2) leaflet: 10 (13.5%) patients with cleft of anterior leaflet, 61 (82.4%) with leaflet prolapse including 56 (91.8%) with anterior leaflet prolapse; (3) annulus: 71 (95.9%) patients with annular dilatation. Leaflet foldoplasty was performed in 61 (82.4%) patients with leaflet prolapse. All patients were successfully discharged and 4 (5.4%) patients were with moderate MR. The follow-up time was 22.0 (9.1-41.8) months. During the follow-up period, 3 patients had moderate MR and 1 patient had reoperation for severe MR. All patients were in normal cardiac function with a mean left ventricular ejection fraction of 66.0%±6.1%. In addition, the mean left ventricular end-diastolic dimension was 31.8±6.0 mm, which was significant smaller than that before the operation (t=6.090, P<0.000 1).Conclusion The standardized leaflet foldoplasty with resection of mal-connected chordae tendineae and posterior annuloplasty technique is safe and feasible with favorable short-term outcomes in MR patients.

Citation： QI Lei, MA Kai, ZHANG Benqing, PANG Kunjing, MAO Fengqun, ZHANG Sen, WANG Guanxi, FENG Zicong, YANG Yang, YUAN Jianhui, LI Shoujun. Leaflet foldoplasty of mitral valvuloplasty for mitral regurgitation in children. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(4): 421-426. doi: 10.7507/1007-4848.202003032 Copy

1.	Caldarone CA, Raghuveer G, Hills CB, et al. Long-term survival after mitral valve replacement in children aged <5 years: A multi-institutional study. Circulation, 2001, 104(12 Suppl 1): I143-I147.
2.	Baird CW, Myers PO, Marx G, et al. Mitral valve operations at a high-volume pediatric heart center: Evolving techniques and improved survival with mitral valve repair versus replacement. Ann Pediatr Cardiol, 2012, 5(1): 13-20.
3.	Kojori F, Chen R, Caldarone CA, et al. Outcomes of mitral valve replacement in children: A competing-risks analysis. J Thorac Cardiovasc Surg, 2004, 128(5): 703-709.
4.	Isaacson E, Lucjak C, Johnson WK, et al. Mitral valve surgery in neonates, infants, and children: Surgical approach, outcomes, and predictors. Semin Thorac Cardiovasc Surg, 2020. [Epub ahead of print].
5.	Ibezim C, Sarvestani AL, Knight JH, et al. Outcomes of mechanical mitral valve replacement in children. Ann Thorac Surg, 2019, 107(1): 143-50.
6.	Vida VL, Zanotto L, Carrozzini M, et al. Repair techniques for mitral valve insufficiency in children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2018, 21: 41-45.
7.	Baird CW, Marx GR, Borisuk M, et al. Review of congenital mitral valve stenosis: Analysis, repair techniques and outcomes. Cardiovasc Eng Technol, 2015, 6(2): 167-173.
8.	Chemtob RA, Wierup P, Mick S, et al. Choosing the "best" surgical techniques for mitral valve repair: Lessons from the literature. J Card Surg, 2019, 34(8): 717-727.
9.	张本青, 龚丁旭, 焦若男, 等. 先天性二尖瓣关闭不全患儿成形手术近中期结果分析. 中国循环杂志, 2020, 35(5): 500-504.
10.	Sellers RD, Levy MJ, Amplatz K, et al. Left retrograde cardioangiography in acquired cardiac disease: technic, indications and interpretations in 700 cases. Am J Cardiol, 1964, 14: 437-447.
11.	Carpentier A, Branchini B, Cour JC, et al. Congenital malformations of the mitral valve in children. Pathology and surgical treatment. J Thorac Cardiovasc Surg, 1976, 72(6): 854-866.
12.	Chauvaud S, Fuzellier JF, Houel R, et al. Reconstructive surgery in congenital mitral valve insufficiency (Carpentier's techniques): Long-term results. J Thorac Cardiovasc Surg, 1998, 115(1): 84-92.
13.	Oppido G, Davies B, McMullan DM, et al. Surgical treatment of congenital mitral valve disease: Midterm results of a repair-oriented policy. J Thorac Cardiovasc Surg, 2008, 135(6): 1313-1320.
14.	Lee C, Lee CH, Kwak JG, et al. Long-term results after mitral valve repair in children. Eur J Cardiothorac Surg, 2010, 37(2): 267-272.
15.	Delmo Walter EM, Komoda T, Siniawski H, et al. Surgical reconstruction techniques for mitral valve insufficiency from lesions with restricted leaflet motion in infants and children. J Thorac Cardiovasc Surg, 2012, 143(4 Suppl): S48-S53.
16.	Martin E, Del Nido PJ, Nathan M. Technical performance scores are predictors of midterm mortality and reinterventions following congenital mitral valve repair. Eur J Cardiothorac Surg, 2017, 52(2): 218-224.
17.	Hetzer R, Delmo Walter EB, Hübler M, et al. Modified surgical techniques and long-term outcome of mitral valve reconstruction in 111 children. Ann Thorac Surg, 2008, 86(2): 604-613.
18.	MacArthur JW, Cohen JE, Goldstone AB, et al. Nonresectional single-suture leaflet remodeling for degenerative mitral regurgitation facilitates minimally invasive mitral valve Repair. Ann Thorac Surg, 2013, 96(5): 1603-1606.
19.	Stellin G, Bortolotti U, Mazzucco A, et al. Repair of congenitally malformed mitral valve in children. J Thorac Cardiovasc Surg, 1988, 95(3): 480-485.
20.	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 Thorac Cardiovasc Surg, 2014, 148(4): 1459-1466.

1. Caldarone CA, Raghuveer G, Hills CB, et al. Long-term survival after mitral valve replacement in children aged <5 years: A multi-institutional study. Circulation, 2001, 104(12 Suppl 1): I143-I147.
2. Baird CW, Myers PO, Marx G, et al. Mitral valve operations at a high-volume pediatric heart center: Evolving techniques and improved survival with mitral valve repair versus replacement. Ann Pediatr Cardiol, 2012, 5(1): 13-20.
3. Kojori F, Chen R, Caldarone CA, et al. Outcomes of mitral valve replacement in children: A competing-risks analysis. J Thorac Cardiovasc Surg, 2004, 128(5): 703-709.
4. Isaacson E, Lucjak C, Johnson WK, et al. Mitral valve surgery in neonates, infants, and children: Surgical approach, outcomes, and predictors. Semin Thorac Cardiovasc Surg, 2020. [Epub ahead of print].
5. Ibezim C, Sarvestani AL, Knight JH, et al. Outcomes of mechanical mitral valve replacement in children. Ann Thorac Surg, 2019, 107(1): 143-50.
6. Vida VL, Zanotto L, Carrozzini M, et al. Repair techniques for mitral valve insufficiency in children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2018, 21: 41-45.
7. Baird CW, Marx GR, Borisuk M, et al. Review of congenital mitral valve stenosis: Analysis, repair techniques and outcomes. Cardiovasc Eng Technol, 2015, 6(2): 167-173.
8. Chemtob RA, Wierup P, Mick S, et al. Choosing the "best" surgical techniques for mitral valve repair: Lessons from the literature. J Card Surg, 2019, 34(8): 717-727.
9. 张本青, 龚丁旭, 焦若男, 等. 先天性二尖瓣关闭不全患儿成形手术近中期结果分析. 中国循环杂志, 2020, 35(5): 500-504.
10. Sellers RD, Levy MJ, Amplatz K, et al. Left retrograde cardioangiography in acquired cardiac disease: technic, indications and interpretations in 700 cases. Am J Cardiol, 1964, 14: 437-447.
11. Carpentier A, Branchini B, Cour JC, et al. Congenital malformations of the mitral valve in children. Pathology and surgical treatment. J Thorac Cardiovasc Surg, 1976, 72(6): 854-866.
12. Chauvaud S, Fuzellier JF, Houel R, et al. Reconstructive surgery in congenital mitral valve insufficiency (Carpentier's techniques): Long-term results. J Thorac Cardiovasc Surg, 1998, 115(1): 84-92.
13. Oppido G, Davies B, McMullan DM, et al. Surgical treatment of congenital mitral valve disease: Midterm results of a repair-oriented policy. J Thorac Cardiovasc Surg, 2008, 135(6): 1313-1320.
14. Lee C, Lee CH, Kwak JG, et al. Long-term results after mitral valve repair in children. Eur J Cardiothorac Surg, 2010, 37(2): 267-272.
15. Delmo Walter EM, Komoda T, Siniawski H, et al. Surgical reconstruction techniques for mitral valve insufficiency from lesions with restricted leaflet motion in infants and children. J Thorac Cardiovasc Surg, 2012, 143(4 Suppl): S48-S53.
16. Martin E, Del Nido PJ, Nathan M. Technical performance scores are predictors of midterm mortality and reinterventions following congenital mitral valve repair. Eur J Cardiothorac Surg, 2017, 52(2): 218-224.
17. Hetzer R, Delmo Walter EB, Hübler M, et al. Modified surgical techniques and long-term outcome of mitral valve reconstruction in 111 children. Ann Thorac Surg, 2008, 86(2): 604-613.
18. MacArthur JW, Cohen JE, Goldstone AB, et al. Nonresectional single-suture leaflet remodeling for degenerative mitral regurgitation facilitates minimally invasive mitral valve Repair. Ann Thorac Surg, 2013, 96(5): 1603-1606.
19. Stellin G, Bortolotti U, Mazzucco A, et al. Repair of congenitally malformed mitral valve in children. J Thorac Cardiovasc Surg, 1988, 95(3): 480-485.
20. 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 Thorac Cardiovasc Surg, 2014, 148(4): 1459-1466.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Leaflet foldoplasty of mitral valvuloplasty for mitral regurgitation in children

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