Surgical Strategy for Children with Patent Ductus Arteriosus and Mitral Regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LU Zhaohui , ZHU Zhongqun , WANG Shunmin , XU Zhiwei.

Department of Thoracic and Cardiovascular Surgery， Shanghai Children’s Medical Center， Medical School of Shanghai Jiaotong University， Shanghai 200127， P. R. China;

Corresponding author：

Keywords：

Patent ductus arteriosus; 　Mitral regurgitation; 　Surgery; 　Children

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Abstract：　Objective　To optimize surgical treatment for children with patent ductus arteriosus （PDA） and mitral regurgitation （MR） and evaluate its midterm to longterm outcome in terms of MR.　Methods　Between Jan. 2008 and Jan. 2011， 25 children with PDA and MR underwent surgical treatment in Shanghai Children’s Medical Center. There were 14 male patients and 11 female patients with average age of 26.36±40.75 （1.72-142.83）months and average weight of 8.98±6.85 （3.80-36.00） kg. The average diameter of PDA was 7.84±3.10 （3-15）mm. There were 22 children with duct-type PDA and 3 children with window-type PDA. There were 5 children with severe MR， 18 children with moderate　MR， and 2 children with mild MR. Except one child with mitral stenosis who underwent PDA ligation plus mitral　valvuloplasty supported with cardiopulmonary bypass， all other 24 children only underwent PDA ligation through left posterolateral thoracotomy without any management for the mitral valve.　Results　There was no in-hospital death. The average ventilation time in ICU was 6.70±4.39 （3-24） hours. Except one child was reintubated because of asthma， all other children recovered uneventfully without any postoperative complication. All the 25 children were followed up for 329.23±288.39 （29-967） days. During follow-up， 23 children （92.00%） had their MR level　ameliorated in different　degree. Preoperative severe MR in 5 children changed into moderate MR in 2 children and mild MR in 3 children. Preoperative moderate MR in 16 children changed into none MR in 5 children, trivial MR in 5 children and mild MR in 6 children.　Preoperative mild MR in 2 children changed into none MR in 1 child and trivial MR in another child. Two children with preoperative moderate MR had no improvement during follow-up.　Conclusion　For infants and children with PDA and MR， conservative treatment strategy should be carried out. Simple PDA ligation can provide satisfactory clinical outcome， which may also avoid negative complications including myocardial injury caused by cardiopulmonary bypass.

Citation： LU Zhaohui,ZHU Zhongqun,WANG Shunmin,XU Zhiwei.. Surgical Strategy for Children with Patent Ductus Arteriosus and Mitral Regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(6): 589-592. doi: Copy

1.	Child Health， 2010， 46 （4）：159-165.
2.	Rao PS. Percutaneous closure of patent ductus arteriosus——current status. J Invasive Cardiol， 2011， 23 （12）：517-520.
3.	Heuchan AM， Hunter L， Young D. Outcomes following the surgical ligation of the patent ductus arteriosus in premature infants in Scotland. Arch Dis Child Fetal Neonatal Ed， 2012， 97 （1）：F39-F44.
4.	刘军，潘渝，朱昕，等．经左腋下小切口钛夹结扎动脉导管未闭28例．中国胸心血管外科临床杂志， 2009， 16 （2）：155．.
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6.	陆兆辉，王顺民，徐志伟，等．小儿先天性心脏病数据库系统的建立及应用．中华胸心血管外科杂志， 2007， 23 （6）：361-365．.
7.	Fattouch K， Guccione F， Sampognaro R， et al. POINT：efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation：a randomized trial. J Thorac Cardiovasc Surg， 2009， 138 （2）：278-285.
8.	Lee Shu-ting， Lin MH. Color doppler echocardiographic assessment of valvular regurgitation in normal infants. J Formos Med　Assoc， 2010， 109 （1）：56-61.
9.	Buck T， Plicht B， Kahlert P， et al. Effect of dynamic flow rate and orifice area on mitral regurgitant stroke volume quantification using the proximal isovelocity surface area method. J Am Coll Cardiol， 2008， 52 （9）：767-778.
10.	Hobo K， Naoji H， Umezu K， et al. Adult patent ductus　arteriosus：successful surgery with mitral valvuloplasty. Asian　Cardiovasc Thorac Ann， 2009， 17 （3）：302-303.
11.	张卫，郭震，叶伟．二尖瓣成形术的临床应用及疗效分析．中国胸心血管外科临床杂志， 2010， 17 （6）：503-505．.
12.	Feldman T， Foster E， Glower DD， et al. Percutaneous repair or　surgery for mitral regurgitation. N Engl J Med， 2011， 364 （15）：1395-1406.
13.	Kalangos A. The rheumatic mitral valve and repair techniques in children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu， 2012， 15 （1）：80-87.
14.	Hildebrandt N， Schneider C， Schweigl T， et al. Long-term follow-up　after transvenous single coil embolization of patent ductus arteriosus in dogs. J Vet Intern Med， 2010， 24 （6）：1400-1406.
15.	Ganeshalingham A， Finucane K， Hornung T. Isolated congenital mitral valve regurgitation presenting in the first year of Life. J Paediatr.
16.	Jonas RA. Comprehensive surgical management of congenital heart disease. London：Arnold， 2004. 310.
17.	Khoo NS， Smallhorn JF. Mechanism of valvular regurgitation. Curr Opin Pediatr， 2011， 23 （5）：512-517.

1. Child Health， 2010， 46 （4）：159-165.
2. 　Rao PS. Percutaneous closure of patent ductus arteriosus——current status. J Invasive Cardiol， 2011， 23 （12）：517-520.
3. 　Heuchan AM， Hunter L， Young D. Outcomes following the surgical ligation of the patent ductus arteriosus in premature infants in Scotland. Arch Dis Child Fetal Neonatal Ed， 2012， 97 （1）：F39-F44.
4. 　刘军，潘渝，朱昕，等．经左腋下小切口钛夹结扎动脉导管未闭28例．中国胸心血管外科临床杂志， 2009， 16 （2）：155．.
5. 　Chehab G， El-Rassi I， Chokor I， et al. Epidemiology of mitral valve disease in pediatrics：a Lebanese study. J Med Liban， 2011， 59 （4）：197-201.
6. 　陆兆辉，王顺民，徐志伟，等．小儿先天性心脏病数据库系统的建立及应用．中华胸心血管外科杂志， 2007， 23 （6）：361-365．.
7. 　Fattouch K， Guccione F， Sampognaro R， et al. POINT：efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation：a randomized trial. J Thorac Cardiovasc Surg， 2009， 138 （2）：278-285.
8. 　Lee Shu-ting， Lin MH. Color doppler echocardiographic assessment of valvular regurgitation in normal infants. J Formos Med　Assoc， 2010， 109 （1）：56-61.
9. 　Buck T， Plicht B， Kahlert P， et al. Effect of dynamic flow rate and orifice area on mitral regurgitant stroke volume quantification using the proximal isovelocity surface area method. J Am Coll Cardiol， 2008， 52 （9）：767-778.
10. 　Hobo K， Naoji H， Umezu K， et al. Adult patent ductus　arteriosus：successful surgery with mitral valvuloplasty. Asian　Cardiovasc Thorac Ann， 2009， 17 （3）：302-303.
11. 　张卫，郭震，叶伟．二尖瓣成形术的临床应用及疗效分析．中国胸心血管外科临床杂志， 2010， 17 （6）：503-505．.
12. 　Feldman T， Foster E， Glower DD， et al. Percutaneous repair or　surgery for mitral regurgitation. N Engl J Med， 2011， 364 （15）：1395-1406.
13. 　Kalangos A. The rheumatic mitral valve and repair techniques in children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu， 2012， 15 （1）：80-87.
14. 　Hildebrandt N， Schneider C， Schweigl T， et al. Long-term follow-up　after transvenous single coil embolization of patent ductus arteriosus in dogs. J Vet Intern Med， 2010， 24 （6）：1400-1406.
15. 　Ganeshalingham A， Finucane K， Hornung T. Isolated congenital mitral valve regurgitation presenting in the first year of Life. J Paediatr.
16. 　Jonas RA. Comprehensive surgical management of congenital heart disease. London：Arnold， 2004. 310.
17. 　Khoo NS， Smallhorn JF. Mechanism of valvular regurgitation. Curr Opin Pediatr， 2011， 23 （5）：512-517.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Strategy for Children with Patent Ductus Arteriosus and Mitral Regurgitation

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