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Repair of rheumatic mitral regurgitation in children.

Kumar AS - Ann Pediatr Cardiol (2011)

View Article: PubMed Central - PubMed

Affiliation: Pushpanjali Institute of Cardiac Sciences, Pushpanjali Crosslay Hospital, Ghaziabad, UP.

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Considering the disadvantages of prosthetic valve in the pediatric age-group, it is important for surgeons and cardiologists to be aware of the feasibility, techniques and outcomes of MV repair in this subgroup of patients... There are several publications on techniques of repair of MVs for various indications... However, a step-by-step “how to do text” with illustration can only be found in a few publications... The sternotomy incision is preferred in children with additional aortic valve pathology as well... For a superior cosmetic result a right thoracotomy is recommended for older children (15 kg or more)... Cardioplegia is delivered into the aortic root... The superior vena cava (SVC) and inferior vena cava (IVC) are looped... Chordal rupture is treated by i) reattachment of chordae ii) excision of ruptured chordae with a triangular resection of AML tip or Quadrangular resection of a PML scallop... The resultant defect is closed by a 5-0 suture. iii) By Chordal transfer... This step will show any free or ruptured chordae and residual areas of prolapse... An annuloplasty is necessary to remodel and reduce the dilated MV annulus... The AML can now be measured using the standard sizers used for mechanical valves... The atriotomy incision is now closed with 3-0 monofilament using two sutures which begin at either end of the incision... Tricuspid and aortic valve function.

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Technique of chordal shortening: a) a silk suture is passed around both the chorda to be shortened and the opposite (posterior cusp) chorda; b) after the left ventricle has been filled with saline solution, the silk suture is tightened so that the anterior mitral leaflet's degree of prolapse can be assessed and the length of chorda to be shortened (a) can be determined; c) after exposure of the chorda with a traction suture (not shown), a 5-0 polypropylene double-armed suture is taken, and the needle is passed through the chorda and then through the edge of the anterior mitral leaflet close to its point of attachment; and d) the polypropylene suture is tied, shortening the chorda at cusp level. Reproduced with permission from: Kumar AS, Bhan A, Kumar RV, Srivastava S, Sood AS, Gopinath N. Cusp-Level Chordal Shortening for Rheumatic Mitral Regurgitation. Texas H I J 1992, 19, 47-50
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Figure 6: Technique of chordal shortening: a) a silk suture is passed around both the chorda to be shortened and the opposite (posterior cusp) chorda; b) after the left ventricle has been filled with saline solution, the silk suture is tightened so that the anterior mitral leaflet's degree of prolapse can be assessed and the length of chorda to be shortened (a) can be determined; c) after exposure of the chorda with a traction suture (not shown), a 5-0 polypropylene double-armed suture is taken, and the needle is passed through the chorda and then through the edge of the anterior mitral leaflet close to its point of attachment; and d) the polypropylene suture is tied, shortening the chorda at cusp level. Reproduced with permission from: Kumar AS, Bhan A, Kumar RV, Srivastava S, Sood AS, Gopinath N. Cusp-Level Chordal Shortening for Rheumatic Mitral Regurgitation. Texas H I J 1992, 19, 47-50

Mentions: 3. Chordal shortening at cusp level.[67] This technique is illustrated in Figure 6. It is easy to perform. It can be undone and redone. It provides excellent correction AML prolapse, with good long-term results. This procedure is possible in RHD because the chordae are thickened. The chorda to be shortened is located. A silk thread is looped around both the identified chorda and the corresponding opposite (posterior cusp) chorda. The left ventricle is then filled with saline solution, and the length of chorda to be shortened is determined by assessing the AML's degree of prolapse. A traction suture is placed at the tip of the papillary muscle where the chorda originates. Traction on this suture, and counter-traction on the leading edge of the cusp, provided excellent exposure of the chorda. A 5-0 polypropylene double armed suture is taken and the needle passed through the chorda, and then through the edge of the AML close to its point of attachment. If more than 1 chorda need to be shortened, the other end of the suture is passed through the adjacent chorda in a similar fashion. Both needles are then passed through the thickened edge of the cusp and the suture is tied.


Repair of rheumatic mitral regurgitation in children.

Kumar AS - Ann Pediatr Cardiol (2011)

Technique of chordal shortening: a) a silk suture is passed around both the chorda to be shortened and the opposite (posterior cusp) chorda; b) after the left ventricle has been filled with saline solution, the silk suture is tightened so that the anterior mitral leaflet's degree of prolapse can be assessed and the length of chorda to be shortened (a) can be determined; c) after exposure of the chorda with a traction suture (not shown), a 5-0 polypropylene double-armed suture is taken, and the needle is passed through the chorda and then through the edge of the anterior mitral leaflet close to its point of attachment; and d) the polypropylene suture is tied, shortening the chorda at cusp level. Reproduced with permission from: Kumar AS, Bhan A, Kumar RV, Srivastava S, Sood AS, Gopinath N. Cusp-Level Chordal Shortening for Rheumatic Mitral Regurgitation. Texas H I J 1992, 19, 47-50
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104534&req=5

Figure 6: Technique of chordal shortening: a) a silk suture is passed around both the chorda to be shortened and the opposite (posterior cusp) chorda; b) after the left ventricle has been filled with saline solution, the silk suture is tightened so that the anterior mitral leaflet's degree of prolapse can be assessed and the length of chorda to be shortened (a) can be determined; c) after exposure of the chorda with a traction suture (not shown), a 5-0 polypropylene double-armed suture is taken, and the needle is passed through the chorda and then through the edge of the anterior mitral leaflet close to its point of attachment; and d) the polypropylene suture is tied, shortening the chorda at cusp level. Reproduced with permission from: Kumar AS, Bhan A, Kumar RV, Srivastava S, Sood AS, Gopinath N. Cusp-Level Chordal Shortening for Rheumatic Mitral Regurgitation. Texas H I J 1992, 19, 47-50
Mentions: 3. Chordal shortening at cusp level.[67] This technique is illustrated in Figure 6. It is easy to perform. It can be undone and redone. It provides excellent correction AML prolapse, with good long-term results. This procedure is possible in RHD because the chordae are thickened. The chorda to be shortened is located. A silk thread is looped around both the identified chorda and the corresponding opposite (posterior cusp) chorda. The left ventricle is then filled with saline solution, and the length of chorda to be shortened is determined by assessing the AML's degree of prolapse. A traction suture is placed at the tip of the papillary muscle where the chorda originates. Traction on this suture, and counter-traction on the leading edge of the cusp, provided excellent exposure of the chorda. A 5-0 polypropylene double armed suture is taken and the needle passed through the chorda, and then through the edge of the AML close to its point of attachment. If more than 1 chorda need to be shortened, the other end of the suture is passed through the adjacent chorda in a similar fashion. Both needles are then passed through the thickened edge of the cusp and the suture is tied.

View Article: PubMed Central - PubMed

Affiliation: Pushpanjali Institute of Cardiac Sciences, Pushpanjali Crosslay Hospital, Ghaziabad, UP.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Considering the disadvantages of prosthetic valve in the pediatric age-group, it is important for surgeons and cardiologists to be aware of the feasibility, techniques and outcomes of MV repair in this subgroup of patients... There are several publications on techniques of repair of MVs for various indications... However, a step-by-step “how to do text” with illustration can only be found in a few publications... The sternotomy incision is preferred in children with additional aortic valve pathology as well... For a superior cosmetic result a right thoracotomy is recommended for older children (15 kg or more)... Cardioplegia is delivered into the aortic root... The superior vena cava (SVC) and inferior vena cava (IVC) are looped... Chordal rupture is treated by i) reattachment of chordae ii) excision of ruptured chordae with a triangular resection of AML tip or Quadrangular resection of a PML scallop... The resultant defect is closed by a 5-0 suture. iii) By Chordal transfer... This step will show any free or ruptured chordae and residual areas of prolapse... An annuloplasty is necessary to remodel and reduce the dilated MV annulus... The AML can now be measured using the standard sizers used for mechanical valves... The atriotomy incision is now closed with 3-0 monofilament using two sutures which begin at either end of the incision... Tricuspid and aortic valve function.

No MeSH data available.


Related in: MedlinePlus