Short-term outcomes of mitral valvuloplasty for Barlow disease in children_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DONG Shuo , DUAN Yabing , SUN Yangxue , XU Haitao , WANG Ju , DU Chuhao , GAO Manchen ,  YAN Jun

Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

YAN Jun, Email: yanjun.1112@aliyun.com

Keywords：

Barlow disease; mitral valvuloplasty; children; tendon folding; surgery

DOI：

10.7507/1007-4848.202003155

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Objective To explore the clinical effect of mitral valvuloplasty on children with Barlow disease combined with moderate to severe or severe mitral regurgitation.Methods The clinical data of 10 patients with Barlow disease combined with moderate to severe or severe mitral regurgitation in Fuwai Hospital from January 2014 to August 2019 were analyzed retrospectively, including 3 males and 7 females, with a mean age of 8.7±7.9 years. Echocardiography before and during the operation confirmed that the mitral valve leaflets were long and swinging, the valve leaflets and the opposite edge protruded into the left atrium and were higher than the level of the mitral valve rings, the mitral valve rings were dilated, the papillary muscles and tendons were long, and the pathological changes after the operation showed mucoid degenertion of the valve leaflets and tendons, and some fibrous foci hyperplasia. Mitral valve repair included implantation of artificial valve ring, implantation of artificial tendon, posterior leaflets sliding, partial resection of posterior leaflets (excluding sliding), valve leaflets folding, tendon folding, papillary muscle splitting and annular valve contraction (excluding artificial valve ring implantation). The technique of mitral valve repair, early clinical results and follow-up echocardiographic data were analyzed.Results All the patients successfully completed the mitral valve repair. The mean time of aortic occlusion was 73.2±17.4 min, and cardiopulmonary bypass time was 99.5±19.8 min. At the same time, 4 patients received tricuspid valve repair and 1 funnel chest correction. There was no reoperation in perioperative period. The 1-year and 5-year survival rates were 100.0% and 100.0%, respectively. The incidence of below moderate mitral regurgitation was 90.0% at postoperative 1 year and 72.0% at postoperative 5 years.Conclusion For the young children who have Barlow disease and mitral regurgitation, considering the characteristics of heavy lesions, small operation space, and the need to meet the growth and development of valve, it is suggested to adopt the surgical techniques different from those of older children, such as valve ring retraction and tendon folding, if necessary, to adopt "edge to edge" suture, which can shorten aortic occlusion time and achieve good early effects, and its long-term effects still need further follow-up observation. Mitral valvuloplasty technique for Barlow disease similar to that of adults can be used in older children, including implantation of artificial valve ring and implantation of artificial tendon, etc.

Citation： DONG Shuo, DUAN Yabing, SUN Yangxue, XU Haitao, WANG Ju, DU Chuhao, GAO Manchen, YAN Jun. Short-term outcomes of mitral valvuloplasty for Barlow disease in children. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(3): 349-353. doi: 10.7507/1007-4848.202003155 Copy

1.	Hirschfeld SS, Rudner C, Nash CL, et al. Incidence of mitral valve prolapse in adolescent scoliosis and thoracic hypokyphosis. Pediatrics, 1982, 70(3): 451-454.
2.	Bozcali E, Ucpunar H, Sevencan A, et al. A retrospective study of congenital cardiac abnormality associated with scoliosis. Asian Spine J, 2016, 10(2): 226-230.
3.	Disse S, Abergel E, Berrebi A, et al. Mapping of a first locus for autosomal dominant myxomatous mitral-valve prolapse to chromosome 16p11.2-p12.1. Am J Hum Genet, 1999, 65(5): 1242-1251.
4.	Hayek E, Gring CN, Griffin BP. Mitral valve prolapse. Lancet, 2005, 365(9458): 507-518.
5.	Procacci PM, Savran SV, Schreiter SL, et al. Prevalence of clinical mitral-valve prolapse in 1169 young women. N Engl J Med, 1976, 294(20): 1086-1088.
6.	Fornes P, Heudes D, Fuzellier JF, et al. Correlation between clinical and histologic patterns of degenerative mitral valve insufficiency: A histomorphometric study of 130 excised segments. Cardiovasc Pathol, 1999, 8(2): 81-92.
7.	Arfken CL, Schulman P, McLaren MJ, et al. Mitral valve prolapse and body habitus in children. Pediatr Cardiol, 1993, 14(1): 33-36.
8.	Zema MJ, Chiaramida S, DeFilipp GJ, et al. Somatotype and idiopathic mitral valve prolapse. Cathet Cardiovasc Diagn, 1982, 8(2): 105-111.
9.	Braunberger E, Deloche A, Berrebi A, et al. Very long-term results (more than 20 years) of valve repair with Carpentier's techniques in nonrheumatic mitral valve insufficiency. Circulation, 2001, 104(12 Suppl 1): Ⅰ8-Ⅰ11.
10.	David TE, Ivanov J, Armstrong S, et al. Late outcomes of mitral valve repair for floppy valves: Implications for asymptomatic patients. J Thorac Cardiovasc Surg, 2003, 125(5): 1143-1152.
11.	Gokhale SG, Gokhale S. High prevalence of 'mitral valve prolapse syndrome' (MVPS) among older children and adolescents in a contained population. Int J Cardiol, 2013, 168(4): 4307-4308.
12.	Perloff JK, Child JS. Clinical and epidemiologic issues in mitral valve prolapse: Overview and perspective. Am Heart J, 1987, 113(5): 1324-1332.
13.	Gillinov AM, Cosgrove DM, Blackstone EH, et al. Durability of mitral valve repair for degenerative disease. J Thorac Cardiovasc Surg, 1998, 116(5): 734-743.
14.	Suri RM, Schaff HV, Dearani JA, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg, 2006, 82(3): 819-826.
15.	Smedira NG, Selman R, Cosgrove DM, et al. Repair of anterior leaflet prolapse: Chordal transfer is superior to chordal shortening. J Thorac Cardiovasc Surg, 1996, 112(2): 287-291.

1. Hirschfeld SS, Rudner C, Nash CL, et al. Incidence of mitral valve prolapse in adolescent scoliosis and thoracic hypokyphosis. Pediatrics, 1982, 70(3): 451-454.
2. Bozcali E, Ucpunar H, Sevencan A, et al. A retrospective study of congenital cardiac abnormality associated with scoliosis. Asian Spine J, 2016, 10(2): 226-230.
3. Disse S, Abergel E, Berrebi A, et al. Mapping of a first locus for autosomal dominant myxomatous mitral-valve prolapse to chromosome 16p11.2-p12.1. Am J Hum Genet, 1999, 65(5): 1242-1251.
4. Hayek E, Gring CN, Griffin BP. Mitral valve prolapse. Lancet, 2005, 365(9458): 507-518.
5. Procacci PM, Savran SV, Schreiter SL, et al. Prevalence of clinical mitral-valve prolapse in 1169 young women. N Engl J Med, 1976, 294(20): 1086-1088.
6. Fornes P, Heudes D, Fuzellier JF, et al. Correlation between clinical and histologic patterns of degenerative mitral valve insufficiency: A histomorphometric study of 130 excised segments. Cardiovasc Pathol, 1999, 8(2): 81-92.
7. Arfken CL, Schulman P, McLaren MJ, et al. Mitral valve prolapse and body habitus in children. Pediatr Cardiol, 1993, 14(1): 33-36.
8. Zema MJ, Chiaramida S, DeFilipp GJ, et al. Somatotype and idiopathic mitral valve prolapse. Cathet Cardiovasc Diagn, 1982, 8(2): 105-111.
9. Braunberger E, Deloche A, Berrebi A, et al. Very long-term results (more than 20 years) of valve repair with Carpentier's techniques in nonrheumatic mitral valve insufficiency. Circulation, 2001, 104(12 Suppl 1): Ⅰ8-Ⅰ11.
10. David TE, Ivanov J, Armstrong S, et al. Late outcomes of mitral valve repair for floppy valves: Implications for asymptomatic patients. J Thorac Cardiovasc Surg, 2003, 125(5): 1143-1152.
11. Gokhale SG, Gokhale S. High prevalence of 'mitral valve prolapse syndrome' (MVPS) among older children and adolescents in a contained population. Int J Cardiol, 2013, 168(4): 4307-4308.
12. Perloff JK, Child JS. Clinical and epidemiologic issues in mitral valve prolapse: Overview and perspective. Am Heart J, 1987, 113(5): 1324-1332.
13. Gillinov AM, Cosgrove DM, Blackstone EH, et al. Durability of mitral valve repair for degenerative disease. J Thorac Cardiovasc Surg, 1998, 116(5): 734-743.
14. Suri RM, Schaff HV, Dearani JA, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg, 2006, 82(3): 819-826.
15. Smedira NG, Selman R, Cosgrove DM, et al. Repair of anterior leaflet prolapse: Chordal transfer is superior to chordal shortening. J Thorac Cardiovasc Surg, 1996, 112(2): 287-291.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Short-term outcomes of mitral valvuloplasty for Barlow disease in children

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