ABSTRACT
OBJECTIVES: Management of patients with left ventricular inflow and outflow stenotic lesions can be challenging. Our purpose was to characterize such patients and review the long-term outcomes of those requiring mitral valve (MV) surgery. METHODS: We performed a retrospective study of 40 patients with subaortic, aortic and/or arch stenotic lesion(s) who underwent MV surgery between 1985 and 2016. RESULTS: Associated left-sided stenotic lesions included aortic valve stenosis in 20 patients (50%), subaortic stenosis in 19 (47.5%) patients, coarctation in 23 (57.5%) patients and hypoplastic aortic arch in 16 (40%) patients. Nineteen patients (47.5%) had a supravalvular mitral ring and 15 (37.5%) patients had a parachute MV. The overall mortality rate was 32.5% (13 patients) with a mean follow-up of 16.3 ± 1.8 years. Being <6 months of age at the time of MV surgery (P = 0.02) and having had previous neonatal aortic valve and/or arch surgery (P = 0.01) were associated with death. The incidence of reoperation (95% confidence interval) at 1, 5, 10 and 15 years was 38% (23-53%), 54% (38-70%), 68% (53-84%) and 85% (72-98%), respectively. CONCLUSIONS: Results after MV surgery for children with associated left-sided stenotic lesions are closely age-related. The need for mitral intervention shortly after the initial aortic valve and/or arch intervention was a predictor of dismal outcomes.
Subject(s)
Mitral Valve Stenosis , Mitral Valve , Child , Constriction, Pathologic , Eponyms , Humans , Infant, Newborn , Mitral Valve/surgery , Mitral Valve Stenosis/surgery , Retrospective StudiesABSTRACT
Long-term outcomes in children with atrioventricular septal defect (AVSD) and univentricular palliation are of concern, with <60% survival at 25 years.1 Common atrioventricular valves (AVV) often become insufficient in patients with univentricular physiology, leading to heart failure.1,2 We have recently observed that outcomes of children with AVSD who reach Fontan circulation are not as bad as previously thought, provided that the AVV remains competent.1 Common AVV surgery is associated with substantial mortality and reoperation rates.3 Although successful AVV repair is associated with better survival and freedom from reoperation, good quality repair is difficult to achieve in univentricular circulation,3 especially in patients with dextrocardia.4 Herein, we report a patient with unbalanced AVSD and dextrocardia who underwent AVV repair using the "polytetrafluoroethylene (Gore-Tex, W.L. Gore & Associates, Flagstaff, AZ) bridge" technique5 with excellent early outcome.
Subject(s)
Abnormalities, Multiple , Cardiac Valve Annuloplasty , Dextrocardia/physiopathology , Fontan Procedure , Heart Septal Defects/surgery , Heart Valve Prosthesis Implantation , Heart Ventricles/surgery , Hypoplastic Left Heart Syndrome/surgery , Cardiac Valve Annuloplasty/instrumentation , Child , Dextrocardia/diagnosis , Echocardiography, Doppler, Color , Fontan Procedure/adverse effects , Heart Septal Defects/diagnostic imaging , Heart Septal Defects/physiopathology , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/instrumentation , Heart Ventricles/abnormalities , Heart Ventricles/diagnostic imaging , Heart Ventricles/physiopathology , Hemodynamics , Humans , Hypoplastic Left Heart Syndrome/diagnostic imaging , Hypoplastic Left Heart Syndrome/physiopathology , Male , Prosthesis Design , Recovery of Function , Treatment Outcome , Ventricular FunctionSubject(s)
Aortic Valve Insufficiency/surgery , Aortic Valve Prolapse/surgery , Aortic Valve/surgery , Cardiac Valve Annuloplasty , Coronary Stenosis/surgery , Coronary Vessel Anomalies/surgery , Suture Techniques , Truncus Arteriosus, Persistent/surgery , Aortic Valve/abnormalities , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/physiopathology , Aortic Valve Prolapse/diagnostic imaging , Aortic Valve Prolapse/physiopathology , Blood Vessel Prosthesis Implantation , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/physiopathology , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/physiopathology , Female , Heart Septal Defects, Ventricular/diagnostic imaging , Heart Septal Defects, Ventricular/physiopathology , Heart Septal Defects, Ventricular/surgery , Hemodynamics , Humans , Infant, Newborn , Pericardium/transplantation , Recovery of Function , Treatment Outcome , Truncus Arteriosus, Persistent/diagnostic imaging , Truncus Arteriosus, Persistent/physiopathologySubject(s)
Ductus Arteriosus, Patent , Acetaminophen , Gestational Age , Humans , Infant , Infant, Newborn , Infant, Premature , LigationSubject(s)
Cardiac Surgical Procedures , Ventricular Dysfunction , Heart Ventricles , Humans , Tricuspid ValveABSTRACT
We herein describe the successful surgical repair of a very rare combination of an aorta-to-left ventricle tunnel with the right coronary artery arising from it. The neonate presented with signs of heart failure due to significant regurgitation of blood via the tunnel. The closure of the tunnel was feasible during neonatal period without patches.