Causes and management of reoperation for mitral regurgitation in children with congenital heart disease / 中华胸心血管外科杂志

ABSTRACT

Objective:To explore the causes and management of reoperation for mitral regurgitation in children with congenital heart disease.Methods:Twenty-four patients required reoperation for moderate to severe mitral regurgitation after mitral valve repair. The median age was 6.7 years, ranging 7 months to 14 years; and their median weight was 18.5 kg, ranging 9.2 to 47.0 kg. Among the patients who underwent reoperation for mitral insufficiency, mitral valvuloplasty was performed in 23 cases and mitral valve replacement was performed in 1 case. Reoperation for mitral valvuloplasty was performed in 7 cases after repair for partial endocardial cushion defect, 3 cases after repair for complete endocardial cushion defect, 11 cases after mitral valvuloplasty combined with other intracardiac malformations, 3 cases after mitral valvuloplasty. Reoperation for mitral replacement was performed in 1 case after mitral valvuloplasty. Reasons for reoperation included enlargement of annulus, prolapse of valves, cleft of valves, perforation of valves, avulsion of original suture and hemolysis.Results:There was no early and later death during the follow-up. Enlarged mitral annulus in 21 cases, cleft valve in 14 cases, valve prolapse in 9 cases, valve perforation in 3 cases, relaxation of tendon chord in 1 case, shortening of tendon chord in 1 case, loss of tendon chord in 2 cases and avulsion of original suture in 3 cases were confirmed. Mitral annuloplasty, annular junction contraction, cleft closure, aberrant orifice closure, Chordae shortening or neo-chordae implantation, prosthetic ring and mitral valve replacement were performed in these cases. The mean cardiopulmonary bypass time and aorta clamp time were(129.8±69.9)min and(69.1±41.1)min. Echocardiograghy revealed slight and mild mitral regurgitation in 21 cases, moderate mitral regurgitation in 2 cases and severe mitral regurgitation in 1 case. During the follow-up for 7 to 84 months. Six months after discharge, 21 cases showed slight and mild mitral regurgitation and 3 cases had moderate mitral regurgitation.Conclusion:The main reasons for reoperation of mitral insufficiency in children are mainly due to the progress of valvular disease or inappropriate suture in the first operation. The clinical results were excellent after reoperation for mitral valve insufficiency.