Yoshizawa Kosuke, Fujiwara Keiichi, Ohno Nobuhisa, Watanabe Kentaro, Sakazaki Hisanori
1 Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan.
2 Department of Pediatric Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan.
World J Pediatr Congenit Heart Surg. 2019 Jan;10(1):37-41. doi: 10.1177/2150135118809076.
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.
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.
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.
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.
婴儿因腱索断裂导致的特发性急性二尖瓣反流需要进行急诊外科治疗。然而，针对这类患者群体的二尖瓣修复仍然具有挑战性。我们报告了我们对婴儿因腱索断裂导致的特发性急性二尖瓣反流进行二尖瓣修复的经验。
2005年至2017年，6例婴儿（4例男孩）被诊断为因腱索断裂导致急性二尖瓣反流，并接受了二尖瓣修复。中位年龄、平均体重和中位随访时间分别为5.5个月（范围：4 - 9个月）、6.8千克（范围：5.5 - 8.0千克）和6.4年（范围：6个月至10年）。
所有病例均在入院后24小时内进行了手术干预。分别有3例和4例采用了人工腱索重建和瓣环旁缘对缘修复，所有病例均进行了凯氏瓣环成形术。平均体外循环时间和主动脉阻断时间分别为117分钟（范围：70 - 143分钟）和73分钟（范围：35 - 108分钟）。随访期间未发生早期或晚期死亡及再次手术。此外，术后二尖瓣反流明显减少，且未观察到二尖瓣反流的时间性进展。
人工腱索重建、瓣环旁缘对缘修复和凯氏瓣环成形术等多种技术的联合应用，对于婴儿因腱索断裂导致的特发性急性二尖瓣反流可能是一种有前景的手术选择。
