Related Experiment Videos
Clinical course and hemodynamic observations after supraannular mitral valve replacement in infants and children
I Adatia1, P M Moore, R A Jonas
1Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA. ian.adatia@mailhub.sickkids.on.ca
Insights
Supraannular mitral valve replacement offers relief for children with mitral valve disease. However, elevated left atrial pressures and diastolic gradients persist, impacting long-term outcomes.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Biomedical Engineering
Background:
- Pediatric mitral valve disease poses management challenges, especially when the annulus is too small for standard prostheses.
- Supraannular valve placement, positioned within the left atrium, is an alternative surgical option.
Purpose of the Study:
- To report the clinical course and unique hemodynamic findings following supraannular mitral valve prosthesis implantation in pediatric patients.
- To evaluate the efficacy and potential complications of this specialized surgical approach.
Main Methods:
- Retrospective review of 17 pediatric patients (median age 10 months) who underwent supraannular mitral valve prosthesis placement between 1980 and 1994.
- Analysis of pre- and post-operative hemodynamic data, including pressure gradients and wave analysis.
Main Results:
- Actuarial survival rates were 88% at 1 month, decreasing to 53% at 10 years.
- Significant reduction in the "a" wave to left ventricular end-diastolic pressure gradient (17 to 4 mm Hg, p=0.003) and "a" wave pressure (30 to 19 mm Hg, p=0.006).
- Elevated mean left atrial pressure (20 mm Hg) and left ventricular end-diastolic pressure (16 mm Hg) persisted post-operatively, with notable atrial "v" waves.
Conclusions:
- Supraannular mitral valve replacement effectively addresses mitral stenosis or regurgitation in pediatric patients.
- Persistent elevated left atrial pressures and diastolic gradients, even without prosthetic obstruction, are observed.
- The presence of left heart obstructive lesions and hypertension contributes to a guarded long-term prognosis.
Objectives:
We report the clinical course and unique hemodynamic findings after placement of a supraannular mitral valve prosthesis.
Background:
Children with symptomatic mitral valve disease whose annulus is too small for the smallest prosthesis are difficult to manage. One option is valve replacement with a prosthesis positioned entirely within the left atrium (LA).
Methods:
We reviewed 17 patients (median age 10 months) with symptomatic mitral valve disease who underwent placement of a supraannular valve prosthesis between 1980 and 1994.
Results:
The actuarial survival rates were 88% at 1 month and 71%, 62% and 53% at 1, 2 and 10 years, respectively. Preoperative hemodynamic data (mean +/- SD)) compared with those after placement of the supraannular mitral prosthesis were as follows: "a" wave to left ventricular end-diastolic pressure gradient 17 +/- 5 versus 4 +/- 4 mm Hg (p = 0.003), mean LA pressure 25 +/- 6 versus 20 +/- 6 mm Hg (p = 0.07), "a" wave 30 +/- 6 versus 19 +/- 5 mm Hg (p = 0.006), "v" wave 28 +/- 5 versus 30 +/- 9 mm Hg (p = 0.31), mean pulmonary artery pressure 54 +/- 19 versus 42 +/- 15 mm Hg (p = 0.07) and left ventricular end-diastolic pressure 14 +/- 5 versus 16 +/- 4 mm Hg (p = 0.12).
Conclusions:
Supraannular mitral valve replacement provides relief of mitral stenosis or mitral regurgitation. However, LA to left ventricular early diastolic gradients with large atrial "v" waves contribute to elevated mean LA pressures in the absence of prosthetic valve obstruction or regurgitation. As a result of this unexpected finding, associated left heart obstructive lesions and pulmonary and left ventricular end-diastolic hypertension, the outlook remains poor.