Neonatal Mitral and Tricuspid Valve Repair for In Utero Papillary Muscle Rupture

Petros V. Anagnostopoulos, Nelson Alphonso, Lars Nölke, Lisa K. Hornberger, Gary W. Raff, Anthony Azakie, Tom R. Karl

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Papillary muscle rupture in the fetus and neonate is a rare event that leads to severe mitral or tricuspid insufficiency and is associated with high perinatal mortality. We undertook surgical repair of this lesion in the neonatal period and report on our midterm results. Methods: Three neonates with tricuspid insufficiency and 1 infant with mitral insufficiency, all due to papillary muscle or chordal rupture, underwent surgical repair with artificial chordal replacement and a modification of the de Vega annuloplasty technique that allowed external adjustment of the annulus size under transesophageal echocardiographic guidance after separation from cardiopulmonary bypass. Results: All patients recovered well from the operation. There have been no late deaths and no valve-related complications. On discharge, all 3 patients had evidence of trace to mild atrioventricular valve regurgitation. At a median follow-up of 33 months (range, 7 to 50; 123 patient-months), all 4 patients are growing normally. Three patients have had no change in the degree of tricuspid or mitral regurgitation. One patient required reoperation at 54 months postoperatively for acute mitral insufficiency secondary to separation of an artificial chorda from the ventricular wall. Conclusions: Surgical repair of critical neonatal tricuspid and mitral insufficiency associated with papillary muscle or chordal rupture is feasible and can result in good early and midterm results. Our modification of the De Vega annuloplasty technique with the ability to externally adjust the size of the annulus under echocardiographic guidance may improve the accuracy of the repair in the neonate.

Original languageEnglish (US)
Pages (from-to)1458-1462
Number of pages5
JournalAnnals of Thoracic Surgery
Volume83
Issue number4
DOIs
StatePublished - Apr 2007
Externally publishedYes

Fingerprint

Tricuspid Valve
Papillary Muscles
Mitral Valve
Rupture
Mitral Valve Insufficiency
Newborn Infant
Tricuspid Valve Insufficiency
Perinatal Mortality
Cardiopulmonary Bypass
Reoperation
Fetus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Anagnostopoulos, P. V., Alphonso, N., Nölke, L., Hornberger, L. K., Raff, G. W., Azakie, A., & Karl, T. R. (2007). Neonatal Mitral and Tricuspid Valve Repair for In Utero Papillary Muscle Rupture. Annals of Thoracic Surgery, 83(4), 1458-1462. https://doi.org/10.1016/j.athoracsur.2006.10.077

Neonatal Mitral and Tricuspid Valve Repair for In Utero Papillary Muscle Rupture. / Anagnostopoulos, Petros V.; Alphonso, Nelson; Nölke, Lars; Hornberger, Lisa K.; Raff, Gary W.; Azakie, Anthony; Karl, Tom R.

In: Annals of Thoracic Surgery, Vol. 83, No. 4, 04.2007, p. 1458-1462.

Research output: Contribution to journalArticle

Anagnostopoulos, PV, Alphonso, N, Nölke, L, Hornberger, LK, Raff, GW, Azakie, A & Karl, TR 2007, 'Neonatal Mitral and Tricuspid Valve Repair for In Utero Papillary Muscle Rupture', Annals of Thoracic Surgery, vol. 83, no. 4, pp. 1458-1462. https://doi.org/10.1016/j.athoracsur.2006.10.077
Anagnostopoulos, Petros V. ; Alphonso, Nelson ; Nölke, Lars ; Hornberger, Lisa K. ; Raff, Gary W. ; Azakie, Anthony ; Karl, Tom R. / Neonatal Mitral and Tricuspid Valve Repair for In Utero Papillary Muscle Rupture. In: Annals of Thoracic Surgery. 2007 ; Vol. 83, No. 4. pp. 1458-1462.
@article{59f2f77717aa409796376aee526b61ce,
title = "Neonatal Mitral and Tricuspid Valve Repair for In Utero Papillary Muscle Rupture",
abstract = "Background: Papillary muscle rupture in the fetus and neonate is a rare event that leads to severe mitral or tricuspid insufficiency and is associated with high perinatal mortality. We undertook surgical repair of this lesion in the neonatal period and report on our midterm results. Methods: Three neonates with tricuspid insufficiency and 1 infant with mitral insufficiency, all due to papillary muscle or chordal rupture, underwent surgical repair with artificial chordal replacement and a modification of the de Vega annuloplasty technique that allowed external adjustment of the annulus size under transesophageal echocardiographic guidance after separation from cardiopulmonary bypass. Results: All patients recovered well from the operation. There have been no late deaths and no valve-related complications. On discharge, all 3 patients had evidence of trace to mild atrioventricular valve regurgitation. At a median follow-up of 33 months (range, 7 to 50; 123 patient-months), all 4 patients are growing normally. Three patients have had no change in the degree of tricuspid or mitral regurgitation. One patient required reoperation at 54 months postoperatively for acute mitral insufficiency secondary to separation of an artificial chorda from the ventricular wall. Conclusions: Surgical repair of critical neonatal tricuspid and mitral insufficiency associated with papillary muscle or chordal rupture is feasible and can result in good early and midterm results. Our modification of the De Vega annuloplasty technique with the ability to externally adjust the size of the annulus under echocardiographic guidance may improve the accuracy of the repair in the neonate.",
author = "Anagnostopoulos, {Petros V.} and Nelson Alphonso and Lars N{\"o}lke and Hornberger, {Lisa K.} and Raff, {Gary W.} and Anthony Azakie and Karl, {Tom R.}",
year = "2007",
month = "4",
doi = "10.1016/j.athoracsur.2006.10.077",
language = "English (US)",
volume = "83",
pages = "1458--1462",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "4",

}

TY - JOUR

T1 - Neonatal Mitral and Tricuspid Valve Repair for In Utero Papillary Muscle Rupture

AU - Anagnostopoulos, Petros V.

AU - Alphonso, Nelson

AU - Nölke, Lars

AU - Hornberger, Lisa K.

AU - Raff, Gary W.

AU - Azakie, Anthony

AU - Karl, Tom R.

PY - 2007/4

Y1 - 2007/4

N2 - Background: Papillary muscle rupture in the fetus and neonate is a rare event that leads to severe mitral or tricuspid insufficiency and is associated with high perinatal mortality. We undertook surgical repair of this lesion in the neonatal period and report on our midterm results. Methods: Three neonates with tricuspid insufficiency and 1 infant with mitral insufficiency, all due to papillary muscle or chordal rupture, underwent surgical repair with artificial chordal replacement and a modification of the de Vega annuloplasty technique that allowed external adjustment of the annulus size under transesophageal echocardiographic guidance after separation from cardiopulmonary bypass. Results: All patients recovered well from the operation. There have been no late deaths and no valve-related complications. On discharge, all 3 patients had evidence of trace to mild atrioventricular valve regurgitation. At a median follow-up of 33 months (range, 7 to 50; 123 patient-months), all 4 patients are growing normally. Three patients have had no change in the degree of tricuspid or mitral regurgitation. One patient required reoperation at 54 months postoperatively for acute mitral insufficiency secondary to separation of an artificial chorda from the ventricular wall. Conclusions: Surgical repair of critical neonatal tricuspid and mitral insufficiency associated with papillary muscle or chordal rupture is feasible and can result in good early and midterm results. Our modification of the De Vega annuloplasty technique with the ability to externally adjust the size of the annulus under echocardiographic guidance may improve the accuracy of the repair in the neonate.

AB - Background: Papillary muscle rupture in the fetus and neonate is a rare event that leads to severe mitral or tricuspid insufficiency and is associated with high perinatal mortality. We undertook surgical repair of this lesion in the neonatal period and report on our midterm results. Methods: Three neonates with tricuspid insufficiency and 1 infant with mitral insufficiency, all due to papillary muscle or chordal rupture, underwent surgical repair with artificial chordal replacement and a modification of the de Vega annuloplasty technique that allowed external adjustment of the annulus size under transesophageal echocardiographic guidance after separation from cardiopulmonary bypass. Results: All patients recovered well from the operation. There have been no late deaths and no valve-related complications. On discharge, all 3 patients had evidence of trace to mild atrioventricular valve regurgitation. At a median follow-up of 33 months (range, 7 to 50; 123 patient-months), all 4 patients are growing normally. Three patients have had no change in the degree of tricuspid or mitral regurgitation. One patient required reoperation at 54 months postoperatively for acute mitral insufficiency secondary to separation of an artificial chorda from the ventricular wall. Conclusions: Surgical repair of critical neonatal tricuspid and mitral insufficiency associated with papillary muscle or chordal rupture is feasible and can result in good early and midterm results. Our modification of the De Vega annuloplasty technique with the ability to externally adjust the size of the annulus under echocardiographic guidance may improve the accuracy of the repair in the neonate.

UR - http://www.scopus.com/inward/record.url?scp=33947308483&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33947308483&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2006.10.077

DO - 10.1016/j.athoracsur.2006.10.077

M3 - Article

C2 - 17383357

AN - SCOPUS:33947308483

VL - 83

SP - 1458

EP - 1462

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 4

ER -