Posterior mitral leaflet extension using autologous pericardium to repair a hammock mitral valve associated with severe
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CASE REPORT
Posterior mitral leaflet extension using autologous pericardium to repair a hammock mitral valve associated with severe mitral valve regurgitation in a 4‑month‑old boy Toshi Maeda1 · Keiichi Fujiwara1 · Kosuke Yoshizawa1 · Haruko Ishihara2 · Hisanori Sakazaki2 Received: 11 July 2019 / Accepted: 22 November 2019 © The Japanese Association for Thoracic Surgery 2019
Abstract We successfully repaired a hammock mitral valve associated with severe mitral valve regurgitation in a 4-month-old boy using posterior leaflet extension along with glutaraldehyde-treated autologous pericardium and the splitting of bilateral papillary muscles. Surgical reinterventions were performed for the bilateral papillary muscles at 14 and 24 months postoperatively. The extended autologous pericardium was still pliable with mild mitral valve regurgitation at 26 months postoperatively. Keywords Hammock mitral valve · Mitral valve regurgitation · Posterior leaflet extension · Autologous pericardium · Mitral valve repair
Introduction
Case
Reconstruction of congenital mitral valve malformation with complex morphology is still challenging [1–4]. Of all mitral valves, hammock mitral valves, which are characterized by abnormally positioned bilateral papillary muscles directly attached to leaflets [5], are rare and associated with high risk in terms of mitral valve replacement [6–9]. Here we describe the case of 4-month-old boy with a hammock mitral valve and severe mitral valve regurgitation who was successfully treated using posterior leaflet extension along with autologous pericardium and the splitting of bilateral papillary muscles.
A 4-month-old boy weighing 4.7 kg was referred to our hospital; he was suffering from congestive heart failure due to severe mitral valve regurgitation. At birth (gestation 37 weeks and 5 days; weight 2.2 kg), mild mitral valve regurgitation and patent ductus arteriosus, which was closed within a week, were noted. His physical examination revealed systolic murmur at the apex (Levine 3/6) with gallop rhythm, and his chest X-ray demonstrated cardiomegaly (cardiothoracic ratio, 62%) with severe pulmonary congestion. Transthoracic echocardiography (TTE) revealed severe mitral valve regurgitation with hypoplasia of the posterior leaflet, and two large and elongated bilateral papillary muscles that were directly attached to the leaflets under bilateral commissures (Fig. 1). The diameter of the mitral annulus was 15.0 mm (115% of the normal). The peak inflow velocity (Vmax) of the mitral valve was 1.8 m/s. The operative procedures used herein are represented in Figs. 2 and 3. After performing standard median sternotomy, autologous pericardium was harvested and immersed in 0.625% glutaraldehyde for 5 min, and then rinsed three times with normal saline. After cardioplegic arrest under cardiopulmonary bypass (CPB) with bicaval and ascending aortic cannulation, a right-sided left atriotomy was performed. The bilateral commissures of the mitral valve were fused, and under the commissures, elongated bilater
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