Surgical treatment for mitral valve regurgitation in children by artificial chords_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Shun , DONG Shuo , ZOU Mengxuan , SUN Yangxue , DU Chuhao , DONG Jie , LI Shoujun ,  YAN Jun

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

Corresponding author：

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

Keywords：

Artificial chords; children; mitral valve regurgitation; surgical treatment; review

DOI：

10.7507/1007-4848.202301044

Video：

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Artificial chords is a mature mitral valve repair technique, especially in adult mitral valve repair. It is still challenging to repair mitral valve in children with artificial chords because the quality of mitral valve is soft and immature. There are some differences in the methods of suture, the choice of suture size and the number of artificial chords. Although the artificial chords could not grow naturally, we found through the long-term research that most children did not have mitral valve restriction or even chords rupture due to itself can compensate through the growth of the flap and papillary muscle. This article summarizes the recent research progress on the treatment of mitral valve insufficiency in children with artificial chordae and provides advise for clinical treatment.

1.	David TE, Bos J, Rakowski H. Mitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg, 1991, 101(3): 495-501.
2.	Vendramin I, Milano AD, Pucci A, et al. Artificial chordae for mitral valve repair. J Card Surg, 2022, 37(11): 3722-3728.
3.	Savic V, Pozzoli A, Gülmez G, et al. Transcatheter mitral valve chord repair. Ann Cardiothorac Surg, 2018, 7(6): 731-740.
4.	Iddawela S, Joseph PJS, Ganeshan R, et al. Paediatric mitral valve disease―From presentation to management. Eur J Pediatr, 2022, 181(1): 35-44.
5.	Kawahira Y, Yagihara T, Uemura H, et al. Use of expanded polytetrafluoroethylene sutures as artificial tendinous cords in children with congenital mitral regurgitation. Eur J Cardiothorac Surg, 1999, 15(3): 289-293.
6.	Torigoe T, Sakaguchi H, Kitano M, et al. Clinical characteristics of acute mitral regurgitation due to ruptured chordae tendineae in infancy-experience at a single institution. Eur J Pediatr, 2012, 171(2): 259-265.
7.	Yoshizawa K, Fujiwara K, Ohno N, et al. Idiopathic acute mitral regurgitation due to chordal rupture in infants: Surgical management and results. World J Pediatr Congenit Heart Surg, 2019, 10(1): 37-41.
8.	Dun Y, Xing J, Zhao D, et al. Mitral valve repair with artificial chordae replacement in children: A single-center experience. Gen Thorac Cardiovasc Surg, 2021, 69(10): 1383-1391.
9.	Sivalingam S, Haranal M, Moorthy PSK, et al. mid-term results comparing the use of artificial chords versus native chords for mitral valve repair in children. World J Pediatr Congenit Heart Surg, 2020, 11(5): 579-586.
10.	Kluin J, Sojak V, Koolbergen DR, et al. Fifteen years' experience with the use of artificial chords for valve reconstruction in children. Eur J Cardiothorac Surg, 2017, 52(6): 1155-1160.
11.	Lim KA, Huh J, Jun TG. Successful repair of critical tricuspid regurgitation secondary to ruptured papillary muscle in a newborn. Cardiol Young, 2004, 14(4): 450-452.
12.	Reddy VM, McElhinney DB, Brook MM, et al. Repair of congenital tricuspid valve abnormalities with artificial chordae tendineae. Ann Thorac Surg, 1998, 66(1): 172-176.
13.	Matsumoto T, Kado H, Masuda M, et al. Clinical results of mitral valve repair by reconstructing artificial chordae tendineae in children. J Thorac Cardiovasc Surg, 1999, 118(1): 94-98.
14.	Murakami T, Yagihara T, Yamamoto F, et al. Artificial chordae for mitral valve reconstruction in children. Ann Thorac Surg, 1998, 65(5): 1377-1380.
15.	Minami K, Kado H, Sai S, et al. Midterm results of mitral valve repair with artificial chordae in children. J Thorac Cardiovasc Surg, 2005, 129(2): 336-342.
16.	Sai S, Konishi A, Sato M, et al. Efficacy of artificial chordal reconstruction for idiopathic severe mitral regurgitation due to chordal rupture in infancy. Semin Thorac Cardiovasc Surg, 2015, Autumn,27(3): 321-325.
17.	Oda S, Nakano T, Tatewaki H, et al. A 17-year experience with mitral valve repair with artificial chordae in infants and children. Eur J Cardiothorac Surg, 2013, 44(1): e40-e45.
18.	Murashita T, Hoashi T, Kagisaki K, et al. Long-term results of mitral valve repair for severe mitral regurgitation in infants: Fate of artificial chordae. Ann Thorac Surg, 2012, 94(2): 581-586.
19.	David TE, Armstrong S, Ivanov J. Chordal replacement with polytetrafluoroethylene sutures for mitral valve repair: A 25-year experience. J Thorac Cardiovasc Surg, 2013, 145(6): 1563-1569.
20.	Salvador L, Mirone S, Bianchini R, et al. A 20-year experience with mitral valve repair with artificial chordae in 608 patients. J Thorac Cardiovasc Surg, 2008, 135(6): 1280-1287.
21.	Vida VL, Zanotto L, Carrozzini M, et al. Repair techniques for mitral valve insufficiency in children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2018, 21: 41-45.
22.	Boon R, Hazekamp M, Hoohenkerk G, et al. Artificial chordae for pediatric mitral and tricuspid valve repair. Eur J Cardiothorac Surg, 2007, 32(1): 143-148.
23.	Brancaccio G, Chinali M, Trezzi M, et al. Outcome for conservative surgery for the correction of severe mitral valve regurgitation in children: A single-center experience. Pediatr Cardiol, 2019, 40(8): 1663-1669.

1. David TE, Bos J, Rakowski H. Mitral valve repair by replacement of chordae tendineae with polytetrafluoroethylene sutures. J Thorac Cardiovasc Surg, 1991, 101(3): 495-501.
2. Vendramin I, Milano AD, Pucci A, et al. Artificial chordae for mitral valve repair. J Card Surg, 2022, 37(11): 3722-3728.
3. Savic V, Pozzoli A, Gülmez G, et al. Transcatheter mitral valve chord repair. Ann Cardiothorac Surg, 2018, 7(6): 731-740.
4. Iddawela S, Joseph PJS, Ganeshan R, et al. Paediatric mitral valve disease―From presentation to management. Eur J Pediatr, 2022, 181(1): 35-44.
5. Kawahira Y, Yagihara T, Uemura H, et al. Use of expanded polytetrafluoroethylene sutures as artificial tendinous cords in children with congenital mitral regurgitation. Eur J Cardiothorac Surg, 1999, 15(3): 289-293.
6. Torigoe T, Sakaguchi H, Kitano M, et al. Clinical characteristics of acute mitral regurgitation due to ruptured chordae tendineae in infancy-experience at a single institution. Eur J Pediatr, 2012, 171(2): 259-265.
7. Yoshizawa K, Fujiwara K, Ohno N, et al. Idiopathic acute mitral regurgitation due to chordal rupture in infants: Surgical management and results. World J Pediatr Congenit Heart Surg, 2019, 10(1): 37-41.
8. Dun Y, Xing J, Zhao D, et al. Mitral valve repair with artificial chordae replacement in children: A single-center experience. Gen Thorac Cardiovasc Surg, 2021, 69(10): 1383-1391.
9. Sivalingam S, Haranal M, Moorthy PSK, et al. mid-term results comparing the use of artificial chords versus native chords for mitral valve repair in children. World J Pediatr Congenit Heart Surg, 2020, 11(5): 579-586.
10. Kluin J, Sojak V, Koolbergen DR, et al. Fifteen years' experience with the use of artificial chords for valve reconstruction in children. Eur J Cardiothorac Surg, 2017, 52(6): 1155-1160.
11. Lim KA, Huh J, Jun TG. Successful repair of critical tricuspid regurgitation secondary to ruptured papillary muscle in a newborn. Cardiol Young, 2004, 14(4): 450-452.
12. Reddy VM, McElhinney DB, Brook MM, et al. Repair of congenital tricuspid valve abnormalities with artificial chordae tendineae. Ann Thorac Surg, 1998, 66(1): 172-176.
13. Matsumoto T, Kado H, Masuda M, et al. Clinical results of mitral valve repair by reconstructing artificial chordae tendineae in children. J Thorac Cardiovasc Surg, 1999, 118(1): 94-98.
14. Murakami T, Yagihara T, Yamamoto F, et al. Artificial chordae for mitral valve reconstruction in children. Ann Thorac Surg, 1998, 65(5): 1377-1380.
15. Minami K, Kado H, Sai S, et al. Midterm results of mitral valve repair with artificial chordae in children. J Thorac Cardiovasc Surg, 2005, 129(2): 336-342.
16. Sai S, Konishi A, Sato M, et al. Efficacy of artificial chordal reconstruction for idiopathic severe mitral regurgitation due to chordal rupture in infancy. Semin Thorac Cardiovasc Surg, 2015, Autumn,27(3): 321-325.
17. Oda S, Nakano T, Tatewaki H, et al. A 17-year experience with mitral valve repair with artificial chordae in infants and children. Eur J Cardiothorac Surg, 2013, 44(1): e40-e45.
18. Murashita T, Hoashi T, Kagisaki K, et al. Long-term results of mitral valve repair for severe mitral regurgitation in infants: Fate of artificial chordae. Ann Thorac Surg, 2012, 94(2): 581-586.
19. David TE, Armstrong S, Ivanov J. Chordal replacement with polytetrafluoroethylene sutures for mitral valve repair: A 25-year experience. J Thorac Cardiovasc Surg, 2013, 145(6): 1563-1569.
20. Salvador L, Mirone S, Bianchini R, et al. A 20-year experience with mitral valve repair with artificial chordae in 608 patients. J Thorac Cardiovasc Surg, 2008, 135(6): 1280-1287.
21. Vida VL, Zanotto L, Carrozzini M, et al. Repair techniques for mitral valve insufficiency in children. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2018, 21: 41-45.
22. Boon R, Hazekamp M, Hoohenkerk G, et al. Artificial chordae for pediatric mitral and tricuspid valve repair. Eur J Cardiothorac Surg, 2007, 32(1): 143-148.
23. Brancaccio G, Chinali M, Trezzi M, et al. Outcome for conservative surgery for the correction of severe mitral valve regurgitation in children: A single-center experience. Pediatr Cardiol, 2019, 40(8): 1663-1669.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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