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Long-term Results After Open Mitral Commissurotomy for a One-Month-Old Infant With Mitral Stenosis
Takashi Kitaichi1, Mikio Sugano, Hiroki Arase
1Department of Cardiovascular Surgery, Graduate School of Biomedical Sciences, Tokushima University.
Insights
A staged surgical approach for congenital mitral stenosis in infants, focusing on left ventricular volume and outflow tract obstruction, led to successful biventricular repair. This strategy promoted long-term left ventricular growth and mitral valve function.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
Background:
- Congenital mitral stenosis (CMS) management requires careful consideration of left ventricular (LV) volume, systemic outflow tract obstruction, and mitral valve dysfunction.
- A staged surgical approach is crucial for optimizing outcomes in infants with complex congenital heart defects.
Observation:
- A neonate with CMS, hypoplastic left ventricle, and coarctation of the aorta presented with limited LV output post-ductal closure.
- Initial repair focused on coarctation of the aorta, followed by spontaneous foramen ovale closure, promoting LV growth.
Findings:
- A staged biventricular repair, including open mitral commissurotomy, was successfully performed in infancy.
- The patient demonstrated sustained LV growth and good mitral valve function for 18 years post-intervention.
Implications:
- Early augmentation of LV inflow via the mitral valve may enhance the growth of a hypoplastic left ventricle.
- A staged surgical strategy can achieve favorable long-term outcomes for complex congenital mitral stenosis.
- This case highlights the importance of individualized treatment plans based on specific hemodynamic factors.
Abstract:
The strategy for an infant with congenital mitral stenosis should be determined by three important factors: left ventricular volume, the degree of the systemic outflow tract obstruction, and the type of mitral valve dysfunction. A successful staged biventricular repair in early infancy for a patient who had congenital mitral stenosis with short chordae, hypoplastic left ventricle and coarctation of the aorta, and the long-term results are described. There were the following important hemodynamic factors that led to the successful biventricular repair in the patient. Total systemic output was barely supplied through the hypoplastic left ventricle after closure of the ductus arteriosus on admission. The neonate underwent repair of coarctation of the aorta alone as the initial stage at 9 days after birth. Also, spontaneous closure of the foramen ovale following repair of coarctation of the aorta accelerated the progressive left ventricular growth. Open mitral commissurotomy with an interatrial fenestration using the modified Brawley's approach was performed for a 40-day-old infant. Good left ventricular growth and good mitral valve function have been observed for 18 years after open mitral commissurotomy. Appropriate early augmentation of left ventricular inflow through the mitral valve might be effective for growth of a hypoplastic left ventricle. J. Med. Invest. 64: 187-191, February, 2017.