Of the associated cardiac defects with absent pulmonary valve, the combination of tricuspid atresia, ventricular septal defect, and aneurysmal dilatation of the pulmonary arteries is very rare. We report the case of a low-birth-weight girl (2,282 g) with this anomaly, which was prenatally diagnosed. Fontan completion was successfully achieved at 16 months of age, following staged palliative procedures including banding of the main pulmonary trunk and plication of the aneurysmal dilated central pulmonary artery.
Objective: Emergency surgical treatment is required for idiopathic acute mitral regurgitation due to chordae rupture in infants. Nevertheless, mitral valve repair for such a patient population still remains challenging. We report our experience with mitral valve repair for idiopathic acute mitral regurgitation due to chordae rupture in infants. Methods: From 2005 to 2017, six infants (four boys) were diagnosed with acute mitral regurgitation due to chordae rupture and underwent mitral valve repair. The median age, mean body weight, and median follow-up period were 5.5 months (range: 4-9 months), 6.8 kg (range: 5.5-8.0 kg), and 6.4 years (range: 6 months to 10 years), respectively. Results: In all cases, surgical intervention was performed within 24 hours of admission. Artificial chordae reconstruction and paracommissural edge-to-edge repair were utilized in three and four cases, respectively, while Kay's annuloplasty was performed in all cases. Mean cardiopulmonary bypass time and aortic cross-clamp time were 117 minutes (range: 70-143 minutes) and 73 minutes (range: 35-108 minutes), respectively. No early or late deaths and reoperations had occurred during the follow-up period. Moreover, postoperative mitral regurgitation was significantly reduced, while no chronologic progression of mitral regurgitation was observed. Conclusions: The combination of various techniques, such as artificial chordae reconstruction, paracomissural edge-to-edge repair, and Kay's annuloplasty, can be a promising surgical option for idiopathic acute mitral regurgitation due to chordae rupture in infants.
Background Mitral valve repair is preferred for pediatric mitral valve disease. However, it is technically difficult because of complex lesions, poor surgical exposure, and tissue fragility, especially in infants. We investigated the midterm outcomes of mitral valve surgery for mitral regurgitation in infancy. Methods We retrospectively reviewed 18 patients (aged <12 months old) undergoing mitral valve surgery for mitral regurgitation at our institution between October 2005 and March 2019. The patients had 10 acquired and 8 congenital valve lesions as follows: torn chordae ( n = 6), leaflet prolapse ( n = 4), posterior leaflet hypoplasia ( n = 3), anterior leaflet cleft ( n = 2), infective endocarditis ( n = 1), papillary muscle rupture ( n = 1), and hammock valve ( n = 1). Results All patients initially underwent mitral valve repair. There was no operative mortality, and 1 case of late death. The median follow-up period was 7 years and 9 months. Reoperation was performed in 3 patients, re-repair (twice) in 1 patient with a hammock valve, and mitral valve replacement in 2 patients. Fifteen patients had at most mild mitral regurgitation at the last follow-up. A transmitral mean pressure gradient of over 5 mm Hg was observed in 3 cases, including the patient with a hammock valve. Postoperative mitral annular diameter increased within the normal range in all patients. Survival and reoperation-free rates at 5 and 10 years were 94.4% and 83.0%, respectively. Conclusions Mitral valve repair for mitral regurgitation in infancy is safe and feasible with satisfactory midterm outcomes, even under serious preoperative conditions.
Background
Sinus of Valsalva aneurysm (SVA) is relatively rare and commonly reported as a congenital anomaly. It is usually found in a single Valsalva sinus protruding into another cardiac chamber and is termed as intracardiac SVA. The aneurysm usually originates from the Valsalva sinus itself, and an orifice of the aneurysm is observed surrounded by the aortic wall. Thus, extracardiac multiple SVAs originating from the orifices with partial aortic wall defects are extremely rare. We report a very rare case of unruptured extracardiac SVAs in both left and right coronary sinuses originating from the aortic annulus.
Case presentation
A 76-year-old Japanese male was diagnosed with enlarged Valsalva sinuses by transthoracic echocardiography during follow-up for peripheral artery disease. Five years after careful observation, gradual SVA enlargement and moderate aortic insufficiency were observed. He underwent modified Bentall’s procedure, with an uneventful postoperative course. Intraoperatively, SVAs were found in the left lateral half of the left and right coronary sinuses of Valsalva on both sides of the commissure between the left and right coronary cusps. Aortic walls were missing at the SVA floor adjacent to the aortic annulus. Pathological examination revealed only mild atherosclerotic changes of the aortic wall near the SVAs. The cause was estimated as either focal degeneration of the sinuses of Valsalva just above the aortic annulus or congenital anomaly, or combination of both of them.
Conclusions
We report on the case of unruptured extracardiac multiple SVAs missing aortic orifice just above the annulus. No similar case presentation was found in the literature. In this paper, we present details of operative findings and procedures, which will aid in procedure selection.
We experienced a case of a 1-year-old female with congenital tricuspid valve regurgitation caused by tricuspid valve dysplasia. The anterior and septal leaflets were particularly dysplastic, and leaflet tethering was observed. The anterior papillary muscle was approximated to the interventricular septum, and a commissural edge-to-edge suture was inserted on the anteroseptal commissure. Tricuspid valve regurgitation improved to be trivial after surgery and has not worsened 1 year later. Papillary muscle approximation could be one of the feasible reparative techniques for congenital tricuspid valve regurgitation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.