Pediatric Cardiology and Cardiac Surgery
Vol.26 No.4 2010 (317-323)
Daiki Miyata,1) Sadamitsu Yanagi,1) Hideaki Ueda,1) Kenichi Hayashi,1) Seiyo Yasui,1) Yoshimichi Kosaka,2) Takayoshi Kajihara,2) Yuko Takeda2) and Toshihide Aso2)
Kanagawa Children Medical Center1) Cardiology and 2)Cardiovascular Surgery, Kanagawa, Japan
Background: Only a few reports have been published in infants with severe mitral regurgitation (SMR). The etiology of SMR has not been well identified so far. The objective of this study is to determine the clinical presentation and mid-term prognosis in infants with SMR.
Methods: Five young children and six infants with MR who were consecutively admitted to our hospital from 2004 to 2008 were reviewed retrospectively.
Results: Four patients were in shock at admission. Pharmacologically refractory shock was noted only in infants with MR for whom medical treatment was initiated early. Following the progression of disseminated intravascular coagulation (DIC) and circulatory failure, these infants were successfully managed by early surgical intervention. In young children with MR, there was no serious patient before the intervention and the time from onset of surgery ranged from four months to two years. The most common cause of infant MR was the rupture of the mitral chordae tendineae, while that of childhood MR was extended tendinous cords or insufficient valve closure. Two infants received mitral valve repairing with artificial chordae and annuloplasty. The other two infants were treated by mitral valve replacement. For the mid-term prognosis of infant MR, no cardiac enlargement was observed at the cardiothoracic ratio (CTR) of 51% (mean). The patients have a good prognosis without significant MR.
Conclusion: Early surgical intervention is required for SMR because it can rapidly progress to death. Once the acute phase is overcome, the mid-term prognosis is usually good in patients with SMR.