Simplified mitral valve repair in pediatric patients with connective tissue disorders

Luca A. Vricella, William A. Ravekes, Eloisa Arbustini, Robert D.B. Jaquiss, Constantine Mavroudis, Harry C. Dietz, Marshall L. Jacobs, Narutoshi Hibino, Duke E. Cameron

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background In pediatric patients with connective tissue disorders (CTDs), early cardiac presentation often involves severe mitral regurgitation (MR) associated with severe bileaflet prolapse and, less frequently, aortic root enlargement. We adopted a simplified repair to address MR and prevent systolic anterior motion (SAM) in this unique group of patients. Materials and Methods Retrospective review of clinical and echocardiographic data of all pediatric patients (age < 18 years) with CTD and MR undergoing simplified repair at 3 institutions (2000-2014). Results Eighteen children who underwent surgery for severe MR and bileaflet prolapse were identified. All were treated with ring annuloplasty and Alfieri edge-to-edge repair. Median age and weight were 8.2 years (range, 0.4-17.2 years) and 24.9 kg (5.6-63.3 kg), respectively. Median left ventricular end diastolic dimension median z score was 4.9 (2.1-11.9). One patient died (5.6%), and there were no other major complications. Among survivors, 94.4% had mild regurgitation or less, with no stenosis or SAM at median clinical follow-up of 2.4 years (range, 0-13.9 years). Median left ventricular end-diastolic dimension z score regressed to 1.3 (−0.5 to 4.3). Conclusions In pediatric patients with CTD and severe MR, a simplified approach is associated with intermediate-term competence, absence of SAM or significant stenosis, and regression of left ventricular enlargement.

Original languageEnglish (US)
Pages (from-to)399-403
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume153
Issue number2
DOIs
StatePublished - Feb 1 2017

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Mitral Valve Insufficiency
Mitral Valve
Connective Tissue
Pediatrics
Prolapse
Pathologic Constriction
Mental Competency
Survivors
Weights and Measures

Keywords

  • connective tissue disorders
  • mitral valve repair

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Simplified mitral valve repair in pediatric patients with connective tissue disorders. / Vricella, Luca A.; Ravekes, William A.; Arbustini, Eloisa; Jaquiss, Robert D.B.; Mavroudis, Constantine; Dietz, Harry C.; Jacobs, Marshall L.; Hibino, Narutoshi; Cameron, Duke E.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 153, No. 2, 01.02.2017, p. 399-403.

Research output: Contribution to journalArticle

Vricella, LA, Ravekes, WA, Arbustini, E, Jaquiss, RDB, Mavroudis, C, Dietz, HC, Jacobs, ML, Hibino, N & Cameron, DE 2017, 'Simplified mitral valve repair in pediatric patients with connective tissue disorders', Journal of Thoracic and Cardiovascular Surgery, vol. 153, no. 2, pp. 399-403. https://doi.org/10.1016/j.jtcvs.2016.09.039
Vricella, Luca A. ; Ravekes, William A. ; Arbustini, Eloisa ; Jaquiss, Robert D.B. ; Mavroudis, Constantine ; Dietz, Harry C. ; Jacobs, Marshall L. ; Hibino, Narutoshi ; Cameron, Duke E. / Simplified mitral valve repair in pediatric patients with connective tissue disorders. In: Journal of Thoracic and Cardiovascular Surgery. 2017 ; Vol. 153, No. 2. pp. 399-403.
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AU - Ravekes, William A.

AU - Arbustini, Eloisa

AU - Jaquiss, Robert D.B.

AU - Mavroudis, Constantine

AU - Dietz, Harry C.

AU - Jacobs, Marshall L.

AU - Hibino, Narutoshi

AU - Cameron, Duke E.

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N2 - Background In pediatric patients with connective tissue disorders (CTDs), early cardiac presentation often involves severe mitral regurgitation (MR) associated with severe bileaflet prolapse and, less frequently, aortic root enlargement. We adopted a simplified repair to address MR and prevent systolic anterior motion (SAM) in this unique group of patients. Materials and Methods Retrospective review of clinical and echocardiographic data of all pediatric patients (age < 18 years) with CTD and MR undergoing simplified repair at 3 institutions (2000-2014). Results Eighteen children who underwent surgery for severe MR and bileaflet prolapse were identified. All were treated with ring annuloplasty and Alfieri edge-to-edge repair. Median age and weight were 8.2 years (range, 0.4-17.2 years) and 24.9 kg (5.6-63.3 kg), respectively. Median left ventricular end diastolic dimension median z score was 4.9 (2.1-11.9). One patient died (5.6%), and there were no other major complications. Among survivors, 94.4% had mild regurgitation or less, with no stenosis or SAM at median clinical follow-up of 2.4 years (range, 0-13.9 years). Median left ventricular end-diastolic dimension z score regressed to 1.3 (−0.5 to 4.3). Conclusions In pediatric patients with CTD and severe MR, a simplified approach is associated with intermediate-term competence, absence of SAM or significant stenosis, and regression of left ventricular enlargement.

AB - Background In pediatric patients with connective tissue disorders (CTDs), early cardiac presentation often involves severe mitral regurgitation (MR) associated with severe bileaflet prolapse and, less frequently, aortic root enlargement. We adopted a simplified repair to address MR and prevent systolic anterior motion (SAM) in this unique group of patients. Materials and Methods Retrospective review of clinical and echocardiographic data of all pediatric patients (age < 18 years) with CTD and MR undergoing simplified repair at 3 institutions (2000-2014). Results Eighteen children who underwent surgery for severe MR and bileaflet prolapse were identified. All were treated with ring annuloplasty and Alfieri edge-to-edge repair. Median age and weight were 8.2 years (range, 0.4-17.2 years) and 24.9 kg (5.6-63.3 kg), respectively. Median left ventricular end diastolic dimension median z score was 4.9 (2.1-11.9). One patient died (5.6%), and there were no other major complications. Among survivors, 94.4% had mild regurgitation or less, with no stenosis or SAM at median clinical follow-up of 2.4 years (range, 0-13.9 years). Median left ventricular end-diastolic dimension z score regressed to 1.3 (−0.5 to 4.3). Conclusions In pediatric patients with CTD and severe MR, a simplified approach is associated with intermediate-term competence, absence of SAM or significant stenosis, and regression of left ventricular enlargement.

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