Timing in resolution of left heart dilation according to the degree of mitral regurgitation in children with ventricular septal defect after surgical closure

Cho, Hwa Jin; Sook, Jae; Cho, Young Kuk; Ahn, Byoung Hee; Na, Kook Joo; Jeong, In Seok

doi:10.1016/j.jped.2013.06.008

Cited by 10 publications

(5 citation statements)

References 13 publications

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“…17 However, early intervention reportedly improves the outcomes of mitral valve repair, because dilation and hypertrophy of the left heart structures can be avoided with early mitral valve repair. 18‐20 In our series, the median surgical age of four months indicates relatively earlier intervention, and the preoperative median left ventricular end-diastolic volume was significantly improved postoperatively. These factors could also have contributed to the good results obtained in our study.…”

Section: Commentmentioning

confidence: 61%

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: 61%

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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“…Hwa et al studied the degree of MR after surgical VSD closure without mitral valve repair in children, and based on the mentioned annular dilatation as the mechanism of MR; they stated the improvement of MR could occur after the reduced left ventricular dilatation [ 21 ]. In this study, mild to moderate MR decreased in 50% of the patients in the first month after the pmVSD closure, and resolved within a year, and in 50% of the patients and the presence of moderate to severe MR the improvement was delayed, and most of them were entirely resolved or decreased to less than moderate after a year [ 21 ]. According to this study, there was no need to do a systematic repair of mitral valve surgery even with moderate MR.…”

Section: Discussionmentioning

confidence: 99%

Mitral and aortic valve regurgitation following surgical and transcatheter perimembranous ventricular septal defect closure in children and adolescents: midterm outcomes

Edraki

Nobahkti

Naghshzan

et al. 2022

BMC Cardiovasc Disord

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Background Closure of perimembranous ventricular septal defects (pmVSD), either surgical or percutaneous, might improve or cause new-onset mitral regurgitation (MR) and aortic regurgitation (AR). We aimed to evaluate the changes in MR and AR after pmVSD closure by these two methods. Material and method We performed a comparative retrospective data review of all pediatric patients with pmVSDs treated at our institution with surgical or antegrade percutaneous methods from 2014 to 2019 and 146 consecutive patients under 18 years were enrolled. We closely looked at the mitral and aortic valve function after repair. Included patients had no or lower than moderate aortic valve prolapse and baseline normal mitral or aortic valve function or less than moderate MR or AR. Results Out of 146 patients, 83 (57%) pmVSDs were closed percutaneously, and 63 (43%) pmVSDs were closed surgically. 80 and 62 patients were included for MR evaluation, and 81 and 62 patients for AR evaluation in percutaneous and surgical groups. The mean follow-up time was 40.48 ± 21.59 months in the surgery group and 20.44 ± 18.66 months in the transcatheter group. Mild to moderate degrees of MR and AR did not change or decreased in most patients. In detail, MR of 70% and AR of 50% of the valves were resolved or decreased in both groups. 13% of patients with no MR developed trivial to mild MR, and 10% of patients with no AR showed mild to moderate AR after pmVSD closure in both methods. There was no significant difference between the two methods regarding emerging new regurgitation or change in the severity of the previous regurgitation. Conclusion pmVSD closure usually improves mild to moderate MR and AR to a nearly similar extent in both percutaneous and surgical methods among children and adolescents. It might lead to the onset of new MR or AR in cases with no regurgitation.

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“…Although VSDs are one of the most common forms of congenital heart disease encountered, with surgical repair of VSD being one of the most common surgeries performed by congenital cardiothoracic surgeons, there is limited literature assessing the “unnatural” history of left heart dilation and its resolution following surgical repair. A similar study by Cho et al9 reviewed pre- and post-operative echocardiographic data of 40 children who underwent surgical repair of VSD, noting that LA dilation was reduced within the first three months after surgical closure, with LV and mitral annular dilation decreasing within the first year. Our results showed a similar but more immediate trend in resolution of LA, mitral annular, and LV dilation, with persistence of some degree of MR into the early follow-up period.…”

Section: Discussionmentioning

confidence: 95%

The Early “Unnatural” History Following Surgical Repair of Ventricular Septal Defects

Chikkabyrappa

Tretter

Doshi

et al. 2019

kjm

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Introduction Surgical outcomes for simple ventricular septaldefects (VSD) have been excellent in the past three decades. Forthis project, the timing of resolution of left-sided dilation and mitralregurgitation (MR) following VSD repair was assessed. Methods Echocardiographic data surrounding surgery of 42 consecutivechildren who underwent surgical patch repair of a VSD werereviewed. The echocardiograms were reviewed up to a mean of 12months post-operatively (range 9 - 14 months). Quantitative dataindexed to body surface area including left atrial (LA) volume, mitralvalve annulus diameter, and left ventricular end-diastolic dimension(LVEDD) was analyzed. Results The majority of our pre-surgical cohort had only trace(44%) or no MR (31%), with a small proportion having mild (16%)or moderate MR (9%). No patients had moderate or greater MR followingrepair at follow-up. The median mitral valve annular Z-scorewas 1.8 (SD 1.6; range: -1.2 to 4.1) pre-operatively, improving to a 0.6(range: -1.7 to 2.4; p < 0.001) at follow-up. LA dilation was present in70% of patients, with a median LA volume Z-score of 1.1 (range: -2.6to 15.5), decreasing to 13% median Z-score -1.2 (range: -3.5 to 2.9; p< 0.001) at follow-up. LV dilation was present in 81% of pre-operativepatients with a median LVEDD Z-score of 3.0 (range: -2.0 to 7.9).There was significant improvement in qualitative assessment of LVenlargement (25%) with a median LVEDD Z-score of 0.5 (range:-2.1 to 2.9; p < 0.001) at follow-up. Discharge echocardiogram wasperformed at a mean of 5.7 days (range: 3 - 12 days) following surgery. Conclusions Normalization of LA, mitral valve annulus, and LV sizeoccurred within the first three months in the majority of patients, withsignificant changes occurring within the first post-operative weekfollowing surgical repair for VSD.

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Timing in resolution of left heart dilation according to the degree of mitral regurgitation in children with ventricular septal defect after surgical closure

Cited by 10 publications

References 13 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

Mitral and aortic valve regurgitation following surgical and transcatheter perimembranous ventricular septal defect closure in children and adolescents: midterm outcomes

The Early “Unnatural” History Following Surgical Repair of Ventricular Septal Defects

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