Long-Term Surgical Outcome for Idiopathic Acute Rupture of Mitral Chordae Tendineae in Infants

Acute rupture of mitral valve chordae tendineae in infants is rare and rapidly leads to cardiorespiratory failure. Acute progression with slight mitral valve annulus dilatation and valve degeneration limits the surgical treatment options. This study investigated the long-term surgical outcomes and factors influencing prognosis.

We assessed 20 infants who underwent surgical treatment for acute mitral valve chordal rupture between 2001 and 2015. The median age was 5.5 months (IQR: 4.5-7.2). Seventeen experienced cardiogenic shock. Twenty had severe mitral regurgitation with a mitral valve diameter z-score of 1.1 (0.06-2.5). The infants underwent mitral valve repair primarily with artificial chordae reconstruction. Mitral valve replacement was performed when regurgitation control was unsuccessful.

The follow-up period was 12.9 (10.6-14.4) years, with no mortality. The number of prolapsed leaflet segments was 3 (1-3). Twelve patients (60%) exhibited intraoperatively yellowish oedematous degeneration of the mitral valve. Although 13 underwent mitral valve repair at initial surgery, 3 were converted to mitral valve replacement before discharge. Consequently, 10 required mitral valve replacement because of uncontrollable mitral regurgitation before discharge. Univariable logistic regression revealed that mitral valve degeneration (odds ratio: 21, P = .015) and the number of prolapsed leaflet segments (odds ratio: 4.6, P = .025) were significantly associated with mitral valve replacement before discharge.

Prompt valve surgery yields good long-term outcomes. Mitral valve repair using artificial chordae reconstruction is a reasonable option for infants. Mitral valve degeneration and numerous prolapsed segments are associated with uncontrollable mitral regurgitation.