Table 5 Surgical information for pediatric patients undergoing mechanical mitral valve replacement
From: The outcomes of reoperation for congenital mitral valve diseases in children
Patients | No.1 | No.2 | No.3 | No.4 | No.5 |
|---|---|---|---|---|---|
Type of diseases | Isolated MR | Isolated MR | Isolated MR | MR combined with CHD | MR combined with CHD |
Intraoperative findings during the initial MV operation | ① Prolapse as well as thickening in A2 area of the anterior MV ② Cleft leaflet in A3 area of the anterior MV and in P2 area of the posterior MV ③ Thin and tender in P3 area of the posterior MV | Cleft leaflet in the anterior MV leaflet (1.5 cm in length) and in the posterior MV leaflet (tiny) | ① Significantly enlarged mitral annulus ② Valve dysplasia, with both anterior and posterior valves differentiating into two leaflets, and both posterior leaflets developing smaller | Significant prolapse in the P2 area of the anterior MV | ① Significant prolapse of the anterior MV ② The posterior MV has less tissue, shorter chordae tendineae, and limited mobility ③Misalignment of anterior and posterior MV |
Surgical method of the initial MV operation | ① Cleft closure (Anterior & Posterior MV) ② Annuloplasty | ① Cleft closure (Anterior & Posterior MV) ② Annuloplasty | ① Annuloplasty | ① Wedge shaped resection of prolapsed valve tissue & closure of the cutting edge ② Annuloplasty | ① Posterior MV is enlarged with bovine pericardial flap (25 mm * 20 mm) ② Suture of artificial chordae tendineae for anterior MV ③ Annuloplasty |
Intraoperative findings during MV reoperation | ① Misalignment of anterior and posterior MV ② Lack of tissue in the anterior MV & anterior MV leaflet prolapse ③Lack of tissue in the posterior MV & posterior MV leaflet curling | ① Tear at the end of the originally sewn cleft ② Thickening and curling of the leading edge of the MV leaflet | ① Thickening and prolapse in A2 area of the anterior MV (with only one set of papillary tendon tension) ② A1 and A3 area of the anterior MV are poorly developed and have very small valve tissue that is difficult to repair ③ The posterior MV splits into two, with P2 absent and only P1 & P3 present, and the valve is extremely poorly developed ④ Anterior and posterior papillary muscle fusion & posterior papillary muscle dysplasia | Severe tearing in A3 area of the anterior MV | Tear of the tissue around constriction suture of the MV annulus, resulting in reduced annuloplasty effect |
Surgical method of MV reoperation | Mechanical MV replacement | ① Cleft closure ② Double-orifice MV technique | ① Fixation of anterior and posterior valve annulus with artificial vascular strips to limit anterior valve prolapse ② Double-orifice MV technique | ① Cleft closure ② Double-orifice MV technique | Mechanical MV replacement |
Intraoperative findings during the second MV reoperation | / | Poor morphology of the MV leaflets | Poor morphology of the anterior MV leaflet | Formation of vegetation in the posterior MV | / |
Surgical method of the second MV reoperation | / | Mechanical MV replacement | Mechanical MV replacement | Mechanical MV replacement | / |