Idiopathic Acute Mitral Regurgitation Due to Chordal Rupture in Infants: Surgical Management and Results

Abstract

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.

Edge-to-edge repair of the systolic anterior motion of mitral valve and cardiac myectomy of the abnormally positioned papillary muscles in an infant with COL4A1 mutation

“…Yoshizawa et al . [ 5 ] reported six infants with idiopathic acute MR who underwent edge-to-edge mitral valve repair. The authors used Kay’s annuloplasty and artificial chordae in some cases and reported no early or late deaths or reoperation.…”

Midterm Outcomes After Surgical Management for Mitral Valve Regurgitation in Infancy

“…In all patients, mitral valve repair was performed, and concomitant cardiac lesions were also repaired (Table 2). As described previously, 5 CV-5 or CV-6 sutures (W. L. Gore & Associates, Inc.) were used as artificial chordae. In patients with posterior mitral leaflet hypoplasia, especially in the P2 region, an autologous pericardium treated for 3-5 minutes with 0.625% glutaraldehyde was applied to augment the posterior leaflet.…”

“…In the case of lesions the affected broad segments or center of leaflets, especially the anterior leaflet, artificial chordal reconstruction was attempted. 5…”

“…In the case of lesions the affected broad segments or center of leaflets, especially the anterior leaflet, artificial chordal reconstruction was attempted. 5 Artificial chordal reconstruction using ePTFE sutures has already been proven to yield excellent long-term results in adult cardiac surgery. 16 In pediatric patients, however, this procedure has been technically challenging.…”

Invited Commentary: A Lesson From Japan: The Art of Repairing the Infant Mitral Valve

“…11 Yoshizawa et al from Hyogo published in the WJPCHS the first paper that selectively reports on a group of infants with acute mitral chordal rupture. 12 There is a detailed description of the typical presentation and the use of polytetrofluoroethylene chordal implantation, edge-to-edge suture, and Kay annuloplasty. They stress the need for prompt transfer to theatre and for 48 h of sedation afterward to avoid hypertension in the early phase postoperatively.…”